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Why your waiter has an M.D.
March 16th, 2012
07:29 AM ET

Why your waiter has an M.D.

Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about his Match Day and becoming a doctor.

I met Sam* in the OR a few years ago. A polite surgical technician in his early 30s, we’d often chat after work.

Sam obtained his medical degree from a school in Eastern Europe prior to immigrating to the United States. Now he spends his days cleaning surgical instruments and his nights working in a restaurant.

“Someday I’ll be a surgeon, just like you,” he says to me.

How did this happen? Sam had a bad Match Day.

Medical training in the U.S. involves four years of medical school followed by 3 to 6 years of residency training. International graduates must also attend residency in the U.S. if they wish to practice here.

On Match Day, graduating medical students learn which residency program they’ll be joining. Residency determines a physician’s field of medicine. For a young doctor to become a pediatrician, for example, he or she must complete a pediatric residency.

This year Match Day occurs today, March 16.

The National Resident Matching Program (NRMP) couples prospective applicants with residency programs, sort of like a medical version of eHarmony. Each applicant makes a list ranking the residency programs in their order of desirability. The residency programs do the same with the applicants, and the NRMP matches them up.
Not all graduating medical students get matched.

According to the NRMP, last year 971 graduates of U.S. medical schools were shut out, accounting for 5.9% of U.S. grads. Graduates of international medical schools fared even worse - less than 50% of them obtained a residency.

That means more than 7,000 doctors were left with a diploma that said “M.D.” but no guarantee they would be able to use it.

Just like Sam.

So what are all of these doctors doing?

The majority of unmatched grads obtain a temporary one-year residency spot with no guarantee of future training. They then reapply the following year with hopes of landing a permanent, multi-year residency position.

Others wind up performing research in labs prior to re-entering the Match. Still others abandon their dreams of becoming a practicing physician and exit the medical field altogether.

This situation is only going to worsen. Due to the pending doctor shortage, the Association of American Medical Colleges (AAMC) has called for a 30% increase in medical school enrollment, or 5,000 more doctors each year. College universities have responded to this demand, with 18 new medical schools currently in the process of opening.

The increase in the number of medical students would lead to an increase in residency positions as well, right?

Wrong.

Since 2001, the number of first year residency positions has increased by 3,000, compared to a whopping increase of 6,500 applicants. The slow growth in residency positions is likely due to a 15 year freeze in Medicare support. The current federal budget problems make lifting the freeze unlikely in the near future.

So what does this mean?

For an unmatched M.D. like Sam, it doesn’t bode well. After going unmatched his first year, he tried to match again the following year, but failed.
As the years pass, it’s becoming more and more likely that Sam will never be able to use the degree he earned.

I watch Sam meticulously clean and rinse the surgical instruments, his hands moving steadily and purposefully. There is not an ounce of unused motion. The fluidity and grace in his hands remind me of my surgical mentors.

Then the sad realization hits me. It doesn’t matter how much Sam wants it.

He will never be a surgeon.

*Sam’s name and identifying details have been changed to protect his privacy.

Update: The National Resident Matching Program has matched 95% of U.S. medical school seniors this year - the highest rate in 30 years, according to a press release sent out on Friday. The largest residency increases were seen in internal medicine, anesthesiology and emergency medicine. Also, 510 more international students were matched than were matched in 2011.


soundoff (505 Responses)
  1. HOW CAN ANYONE WITH COMMON SENSE VOTE FOR REPUBLICANS

    GO libdems!

    March 16, 2012 at 10:47 | Report abuse | Reply
    • Travis

      HOW CAN ANYONE WITH COMMON SENSE VOTE FOR REPUBLICANS OR DEMOCRATS?

      Our two party system is broken beyond repair. Go Independents!

      March 16, 2012 at 11:23 | Report abuse |
    • DrK

      "Foreign" medical grads include ones that go to goes to Univ of Bahamas because they couldn't qualify for any US medical school. It's not a doctor shortage, it's a PRIMARY CARE shortage. 1/3 of all internists will retire within the next years. Also the article neglected to mention that family practice and internal medicine residencies have vacancies every year while docs (like Sam) pursue more lucrative specialties. There's no shortage of Cardiologists in the US.

      This country should fund more primary care residency slots for US medical graduates, increase incentives for primary care docs (like Australia) and increase reimbursement for non-procedural visits. This would do more to allieviate the primary care shortage than importing Foreign Grads who'll make the same as US docs and are MORE likely to settle in overserved areas (like large metropolitan areas).

      March 16, 2012 at 11:28 | Report abuse |
    • Paul Ron

      Libertarian - there is no other logical choice.

      March 16, 2012 at 11:36 | Report abuse |
    • RxDoc

      How can anyone with a brain vote for socialists? Believe it or not, that's what your are doing when you vote 'D'.

      March 16, 2012 at 12:03 | Report abuse |
    • Carl

      Give it a rest.

      March 16, 2012 at 12:04 | Report abuse |
    • u don't get it

      Residency application is a process & the best do NOT always get chosen. Sometimes its who u know, other times its whether your interviewer is having a good day. In surgery, my field, you step 1 board scores (an exam taken between 2nd & 3rd yr medical school) means more then your patient care skills, you ability to work in a group, your leadership skills, your clinical exam skills, even the rest of your medical school grades ! FYI MOST medical schools don't have grades, just pass/fail.
      I initially didn't match cause of a low board score although I was one of the most decorated medical students of my class. However one of my classmates who did well on the boards, and who received numerous complaints for poor patient care in med school and inability to work with others, not to mention straight up said he didn't care what patients said to him, easily matched. The ERAS system is flawed, it allows residency programs to eliminate candidates based on any number of criteria before reviewing the application (like a normal interview process would).
      Who do you want as your surgeon, a good test taker or a good doctor . . .

      March 16, 2012 at 12:12 | Report abuse |
    • equal pay across the board

      When a position in Interventional Radiology pays $700k/year + benefits with 3 months of vacation and Primary Care pays $125k/year and deals with all kinds of patients, you get floods and floods of young M.D.s wanting to be highly paid, lightly worked specialists and few people wanting to work in the trenches for so much less. Level the field. Everyone competent gets paid $200k/year and the field will level itself out. Additionally, all the gold digger guys out there won't even enter medical school and leave residency programs less crammed. It's very, very simple economics.

      March 16, 2012 at 12:55 | Report abuse |
    • E

      Woops. Responded to wrong post.

      DrK. Do a search on cardiology and shortage. You will find that the subspecialty is also experiencing one.

      March 16, 2012 at 12:58 | Report abuse |
    • Bob

      Because the GOP has better track record for prosperity and supports America. Democrats no longer care about the country, and are only interested in keeping people dependent on Government to maintain their power.

      March 16, 2012 at 13:02 | Report abuse |
    • E

      @u don't get it

      That issue is not with ERAS. That issue is with the programs underhandedly using USMLE scores (not their intended purpose).

      March 16, 2012 at 13:04 | Report abuse |
    • Todd C

      @u don't get it,

      Methinks you are a little bitter? Maybe you just aren't as good as you think you are.

      I want a doctor who knows his stuff. For the foreseeable future, a test of knowledge (the boards) is part of the way that is measured. I don't care if you aren't a good test taker. You had a chance to prove you knew your stuff, and you apparently didn't. A good test taker still has to know his stuff in order to succeed. I'll take my chances with him over you any day.

      March 16, 2012 at 13:08 | Report abuse |
    • NJBob

      @RxDoc - How can anyone with any morals or a conscience vote Republican?

      March 16, 2012 at 13:08 | Report abuse |
    • NJBob

      @Bob - You are dead wrong. Republicans get us into recessions. Check your facts!

      March 16, 2012 at 13:11 | Report abuse |
    • Emma

      DrK, there most certainly IS a cardiology shortage. There's a shortage of most specialists. I don't know who told you there wasn't.

      March 17, 2012 at 01:31 | Report abuse |
    • Natsu06

      @RxxD......I don't think you know what the world socialist means...because if you did that would lead me to believe that you are have similarly negatively feelings about socialist programs such as Public Education, Scholarships, THE MILITARY, Local law enforcement, Tax relief, Subsidizing of costs to small businesses, subsidized medical costs, Research programs, Residency programs, student loans, federal bonds, and many more all of these BY DEFINITION are SOCIALIST PROGRAMS....America is a mixed economy. If you want to know what a country that operates on pretty much purely capitalist principles....go to china. Oh and before you say "wait, china is a communist country" look at the economic trends of fund flow in china and compare it to the definition of capitalist and communist. The label was left over from the cultural revolution. http://boingboing.net/2011/07/08/half-of-us-social-pr.html

      March 18, 2012 at 05:31 | Report abuse |
    • Hani Yousef

      I want to share with all of you the rights of US citizens. Do you know that according to NRMP statistics 2012 ,there is 10.000 get residency who are IMG and with H1 or J1 visa and there is 4500 US citizen who are IMG did not get residency. What that means. It means that US citizen will not get work and foreigners from other countries take their jobs. US citizen who pay tax and share in building this country stay jobless and foreigners from other countries take their place in residency. These hospitals take fedral funds from US citizen tax, and these hospitals use these money to help doctors from other countries leaving US citizen jobless. In many other countries they support their citizen first, then if there is shortage they can hire foreigners to help them. But what happened here in USA we leave doctors from other countries to take US citizen opportunities. Does this make sense??? We need our govement to look to this situation and help their citizen first, insteade that these qualified doctors who others take their opportunities ask for unemployment, food stamps and medicaid. I want your opinions.

      March 18, 2012 at 18:50 | Report abuse |
  2. Lee S

    Another proponent for the "weinerfication" of America. Not everyone that plays wins, sorry.

    March 16, 2012 at 10:49 | Report abuse | Reply
    • MHA

      You say that, but you are the same person that will be complaining of long wait times at your local hospital of physician's office. There is a severe shortage of physicians in this country and without an increase in the number of residencies to supplement the increase in graduates, the problem will not begin to be solved.

      March 16, 2012 at 10:56 | Report abuse |
    • Hugh Briss

      This is not a game and you are not "playing" to win. The fact of the matter is, as stated in the article, there are a shortage of doctors but we as a country are failing to utilize our resources effectively. This is merely a symptom of an economy that is designed to reward those who do not "earn income" through real work, but those who merely speculate and add nothing to our society. Disgusting.

      March 16, 2012 at 11:04 | Report abuse |
    • A Messenger

      Sam could easily apply for residency back in his country of origin, problem solved.

      As far as all those POOR MDs without residency goes, too bad so sad. The best get the better positions, and those that aren't as good, don't. This process is what prompts the medical industry to get better and better. If we level the playing field, anyone could be a doctor. I would much rather go to a doctor who had to work very hard to get their degree, to be considered for residency, as opposed to one who was handed a residency out of pity.

      March 16, 2012 at 11:16 | Report abuse |
    • We want Sam

      Sure, Sam could leave the country, but we don't WANT Sam to leave the country. "Too bad so sad" doesn't apply to doctors, sorry. We need more of them and the fact that some fall through the cracks and don't get to utilize their degree in a way that benefits both them and society as a whole is beyond stupid. Can you imagine spending the time, money and effort to get all the way through medical school and then not be able to use the degree? Insanity.

      March 16, 2012 at 11:26 | Report abuse |
    • Doug

      Somehow one just knows that Lee S has never won anything of consequence. Talk about "weinerfication".

      March 16, 2012 at 11:29 | Report abuse |
    • Katie

      The saddest thing about this scenario is that these people worked hard to receive their MD. They WANT to be doctors. It's quite an achievement to get into medical school, even more so to graduate with the degree. They put themselves in debt, put their social lives on hold, and they eat, breathe, and sleep their studies. We WANT doctors who WANT to be doctors, don't we? And soon we won't have enough of them, especially family practice-oriented ones. So much for the best medical system in the world. Every year it seems there is more evidence pointing to how it's much better in other countries.

      March 16, 2012 at 11:46 | Report abuse |
    • Alan S

      Lee: Exactly. I couldn't agree more. Unfortunately, the great majority of Americans now believe they have a "right" to financial security, a right to a job, a right to serve in the military (without participation in any nasty combat), a right to lower taxes (and greater benefits), a right to low gasoline prices for their hulking SUV's, and now - a right to practice medicine.

      March 16, 2012 at 12:15 | Report abuse |
    • Chuck

      Mr. Briss says, ". The fact of the matter is, as stated in the article, there are a shortage of doctors but we as a country are failing to utilize our resources effectively. "

      What is that resource? People with MD degrees, or highly-qualified people with MD degrees?

      Becoming a doctor is a filtering process. First, you have to graduate from high school with good enough grades to get into college. Then, you have to take a demanding course of study in college, usually a technical or scientific major such as biochemistry or physiology, and you have to finish that course near the top of your class to get into medical school. Then, you have to do well in medical school which is a demanding course too. Then, you have to get selected in this match process. Then you have to complete your residency and pass your board exams.

      It's not unlike becoming a professional basketball player. First you do well in JV sports, then you have to make varsity, then you have to be selected by a college, then you have to do well in college, then you get drafted into the NBA, and then you still have to push hard to do well there. How many young boys dream of an NBA career? And yet there are only about 400 NBA players at any time. Obviously, some are filtered out at each stage of the process.

      How many young people dream of becoming a doctor? And yet the system can only handle a limited number of people and give them the training and experience they need. And so some are filtered out at each stage of the process.

      This is good and assures that we have the best quality doctors.

      March 16, 2012 at 12:40 | Report abuse |
    • Chuck

      Ms. Katie objects, "They WANT to be doctors. ... We WANT doctors who WANT to be doctors, don't we?"

      Yes, we certainly do want people who want to be doctors. And the process pretty much guarantees that those who become doctors want to be doctors. What the process does not guarantee is that everyone who want to be a doctor gets to be a doctor.

      It's not enough to want it. You have to prove through multiple steps that you're among the best. This process takes that pool of people who want to be doctors and selects the best-qualified from that pool.

      March 16, 2012 at 12:43 | Report abuse |
    • Emma

      Chuck, you don't know what you're talking about. The Match isn't about weeding people out. That was Organic Chemistry class and the MCAT and the med school admission process and making it to graduation. Once you've passed your boards and graduate med school, you're deemed qualified to be a physician. The Match is simply about training. If it was about anything more than that, then top med schools would match 100% of their students every year, wouldn't they? The fact is that there are people with low scores who match over those with high scores every single year and it's because the system is flawed, there's too much accommodation for foreign doctors over U.S. students, and there aren't enough slots despite the shortage.

      March 17, 2012 at 01:39 | Report abuse |
  3. Lindalou

    I know this is the land of opportunity, but why not go someplace where there is a lack of doctors? Go where your expertise can be used because it's either you or the grave. To let that talent die is a shame.

    March 16, 2012 at 10:49 | Report abuse | Reply
    • kyle

      America HAS a shortage of doctors, but it is not a fixable problem because we have a shortage of training facilities.

      March 16, 2012 at 11:20 | Report abuse |
    • Mike

      US doctors make way more in pay than doctors in other countries, which make running a practice in the US very desirable. But I do see your point.

      March 16, 2012 at 11:31 | Report abuse |
    • Not Shocked

      Hey nimrod – did you fail to read the part about the U.S. having a shortage of doctors? My god the level of stupidity is just astounding.

      March 16, 2012 at 11:37 | Report abuse |
    • Crocky

      With non-profit hospitals having 55% of their income coming from government sources (Medicare/Medicaid), residency programs depend on Medicare reimbursement of IME/GME (Indirect Medical Education/Graduate Medical Education) costs. With those amounts not budging for years, it's becoming more and more cost prohibitive to have these programs in hospitals, even with the incentives that they have in place for primary care residency programs.

      This is why I have such issues with how Congress addressed the healthcare crisis. Why pass new legislation requiring people to carry health insurance when the programs that the government funds already are severely broken? How about fixing those before dictating terms to the rest of us?

      March 16, 2012 at 12:02 | Report abuse |
    • billtouch

      The Problem here is that 'Sam' made a choice to come here and take his chances with our system. He can still go back to his country and use his degree to the benefit of many. He chose to come here because the money is better. A lack of a US residency does not prohib him from completing a residency in his country.

      March 16, 2012 at 12:31 | Report abuse |
    • Shubhada Hooli, MD, MPH

      This article is a great example as to why I rarely read anything on CNN.com – misinformation.

      The United States has one of the highest percentages of physicians per capita. Yet we do not have as effective health outcomes of our European counterparts. The answer to the problem of poor distribution of healthcare services is not training more physicians, its better utilization of existing resources and a shift in the paradigm of healthcare. Healthcare is not about seeing a doctor whenever you want to, its about living in a society that enables one to live a healthy life.

      We need to increase our number of medical student spots, if only to fill our graduate medical education training positions. We poach more physicians trained in other countries to fill our residency positions than the UK, Australia, and Canada combined. And then we wonder why its so difficult for some developing countries to be independent of foreign aide in order to sustain their healthcare systems.

      Frankly, I have never heard of a medical student who did not match in a primary care field (unless they were being very restrictive about location) – its been the radiology or dermatology candidates. We need to create incentives for people to want to stay in the relatively lower primary care specialties. We need to also have the federal government play a more restrictive role in specialty societies who intentionally restrict the number of training positions available in order to restrict the supply of services to keep their salaries high (dermatology).

      March 16, 2012 at 12:43 | Report abuse |
    • Emma

      Shubhada Hooli, for someone who came here to criticize CNN, you're awfully misinformed about your information. The AMA, the AAMC, and the U.S. government ALL say there's a doctor shortage, but you know different. Please cite your sources. Also, candidates fail to match into almost any specialty, not just derm and radiology.

      March 17, 2012 at 01:46 | Report abuse |
  4. Hyperion

    This is an extraordinarily unfortunate situation. Being an MD has always been touted as a good job with smart people however I disagree. All those years of schooling and then you get to pay > half your salary for malpractice insurance and if you make a mistake...gone. People should just boycott med school if the system is that screwed up. Do what Focker did and be a nurse with an awesome schedule.

    March 16, 2012 at 10:52 | Report abuse | Reply
    • ronin001

      LOL...I know of no nurses with awesome schedules! Well, at least not the new ones...

      March 16, 2012 at 10:56 | Report abuse |
    • Mike

      My sister in law is a nurse. Unless your a nurse for a doctor doing a private practice your hours will be bad. At the hospital they start the new nurses on the graveyard shift (3rd shift) as spots open up in the 2nd and 1st those with seniority can move into them. So a new nurse can be stuck for years on the 3rd shift.

      March 16, 2012 at 11:35 | Report abuse |
  5. bob

    It would be the same if the government had a "RestaurantAid" program that paid for your meals for the very poor. Slowly, that program would expand as politicians used it to buy votes. A few more restaurants would open up because there's more money available resulting in more jobs and higher wages for those jobs, the prices would start rising but noone would really care too much at first because "RestaurantAid" is paying for it and there's plenty of tax money to back it up. As the prices rise, more people would claim they need RestaurantAid and they would get it. More restaurants open up, the wages are really going up, more people want to be waiters now because it's such a lucrative field. Now the prices are REALLY getting high, the wages are getting even higher, pretty much EVERYBODY now actually NEEDS RestaurantAid to pay for the littlest things.... funny thing about pyramid schemes though, once you get everybody into the "pay side", there's no more surplus of "someone else's money" to distribute to the payees, all you're doing is trying to redistribute the money amongst all the payees. But, that doesn't mean that the payee's expectations have stopped rising, or the waiters expectation of rising wages has stopped, or the restaurant owners expectation of rising profits has stopped.... or more importantly, the governments need to keep raising taxes on all the above to pay for other programs which are going through the same cycle... It has to at least hit a wall that stops the cyclic inflation of jobs/prices/wages. At some point, RestaurantAid can't keep giving more money, and even starts reducing some of the "benefit",... and fewer restaurants open up as potential profit-making owners see that there's no more profit if the gov isn't kicking in, but the schools are still churning out waiter-wanna-be's who are shopping for Mercedes' even before they finish school. Well, the obvious answer to fix this situation is to just socialize the whole system, put it under government control, tell people when, where, and what they can eat, fix the prices, and the wages, take control of the schools (don't need profiteers training waiters needlessly), and take over the restaurants (don't need too many restaurants pushing prices/wages down which will incite riots)... sound familiar?

    March 16, 2012 at 10:52 | Report abuse | Reply
    • NJBob

      This is so simplistic it's irrelevant.

      March 16, 2012 at 11:21 | Report abuse |
    • billtouch

      I am glad you see some relevance to the article here. If no one ate, wouldn't need restaurants. If no one sought medical care, we wouldn't need the doctors or hospitals. Back in the 50's, no one went to the doctor. I fell 15 ft out of a tree. My mom took me to the couch to sleep it off. Today there would be a trip to the ER and maybe even some ICU time. I think I prefer the ER approach, but it's costly. I took my grandson to the ER when he sliced his finger on a veggie slicer. The bill was $1358.11 for that bandaid! I have to admit, it was a special bandaid though, covered the tip of his finger quite well. But $1358.11??? Of course, the Administrator of the hospital has a $1 million salary. Yeah, I feel much better now.

      March 16, 2012 at 12:40 | Report abuse |
  6. ronin001

    anotherMD sums up my opinions best about Match (aside from the fact that I feel the Match program in of itself is a scam), but yeah, I'm wondering if by "...Sam had a bad Match day." meant that Sam couldn't get his top picks from his Match and chose not to take his lower pics vs they couldn't match Sam to any of the choices he submitted.

    My dad graduated med school from the University of the Philippines, and from what I understand he didn't go through Match at all and ended up getting placed through what he described was like a headhunter, at a hospital in West Philadelphia; not ideal to his thoughts by any stretch, and I don't even know if this exists anymore, but I agree that there are options out there available for MD's that don't Match their first time out.

    March 16, 2012 at 10:54 | Report abuse | Reply
    • Just Matched MD

      If Sam had a bad match day, it means he didn't match at all. Matching through the NRMP Match isn't like getting accepted to college. With college applications, you can get multiple acceptances and pick the one you prefer. The NRMP Match matches applicants to one residency program; if they didn't match, they're basically SOL.

      March 16, 2012 at 11:20 | Report abuse |
  7. Leland D.Davis

    It's curious why residency programs cost money – they take young MD's, make them work 80+ hours a week, with some supervision by more experienced physicians, and get full fee for their work. The residents only take home something like 40K a year, they have gotten rid of most academic/coursework requirements, and many residency programs don't do a research year, which for many specialties used to be a requirement. Yet it is said that residency programs cost thousands of dollars a year per slot. Where does the money go? Are there senior physicians using $100 dollar bills to roll smoking material? Is this just a plot to constrict the supply of physicians?

    March 16, 2012 at 10:57 | Report abuse | Reply
    • kyle

      You don't really understand business very well. If they are getting paid 45k, benefits (like health insurance) are another 15k, then you have the malpractice insurance, then you have to pay the attendings who are training the new doctors more money. The short of it is that it costs a good deal of money to run a residency program, that cost is usually defrayed in the US by the school attached to the program and by being able to accept more patients. I think patients usually get better treatment at teaching facilities because you have a lot more attention on each patient but sadly you can't fit all the residents into hospitals that are attached to schools, and other hospitals are run as businesses not places healing and charity.

      March 16, 2012 at 11:31 | Report abuse |
    • Not Shocked

      Kyle, if you don't think that some people are getting rich off of residency programs, you are REALLY naive. I'll bet you're the same type who hates government regulations because if left to themselves, businessmen would make the "right" decisions and businesses would never hurt people.

      In other words – an idiot.

      March 16, 2012 at 11:42 | Report abuse |
    • rpmi1640

      Those days are gone. Residents now have restricted work hours and require far more supervision than they used to. A residency program is a money loser for a medical center. There are many indirect benefits to having a residency, but no financial ones now that government subsidies have plummeted.

      March 16, 2012 at 11:45 | Report abuse |
    • common sense

      @Kyle

      You forgot all the money the hospital collects for treating those patients. Where does all that go. If there's two hospitals – one with fully trained doctors and one with mostly residents and if they are seeing same number of patients, the hospital with mostly residents is saving a lot of money.

      March 16, 2012 at 11:49 | Report abuse |
    • Crocky

      Incorrect, Kyle. The hospital pays the school for their residents. Medicare rules dictate that in order to receive reimbursement, the hospital has to pay at least 90% of salaries, benefits and other costs associated with training each resident. The costs are defrayed by Medicare and by the patients when they pay their bill.

      March 16, 2012 at 12:07 | Report abuse |
    • kyle

      Sorry I was in a hurry, I didn't me 'defrayed' as in completely covered. I meant subsidized (even 10%) helps, and if that is simply salaries, that is just part of the expenses of running a hospital. Does the hospital also have to cover 90% of equipment costs? Building and maintenance costs? The point is hospitals not attached to schools are businesses and if the residency program is not helping the bottom line then they will not do it because they will not take a hit to their profits simply to improve patient care.

      March 16, 2012 at 22:50 | Report abuse |
    • Emma

      rpmi1640, the work hour restriction regulates that a resident can't work more than 80 hours a week averaged over 4 weeks and some programs actually break that rule, supposedly. But still, 80 hours a week is still a lot.

      March 17, 2012 at 01:51 | Report abuse |
  8. bob

    And the justification for taking over the system is that by this point, the whole economy (which has also been inflating and has experienced other bubble pops/pyramid toppling) is dependent on this money trading hands in the restaurant sector. Also, isn't eating vital for health and survival? Isn't it critical that taxpaying-taxconsuming citizens all eat properly and keep themselves healthy so they can be as productive as possible and NOT cost any more than necesary in HealthCARE?... It just HAS to be socialized and controlled by the benevolent government who we all know we can trust lovingly and blindly... just as Rod Blagojevich...

    March 16, 2012 at 10:58 | Report abuse | Reply
  9. Alejo

    What would be a reason for not getting matched? Is it mainly due to class rank or grades? Or is mainly a supply and demand issue?

    March 16, 2012 at 10:59 | Report abuse | Reply
    • Gadadhoon

      As I understand it, residency programs submit a list of students they would like based mostly on the scores those students got in two standardized exams med students take. The students also submit a list of residency programs they would like to join. So, the two reasons for not getting matched would be either having low scores or trying to get unrealistic residencies.

      March 16, 2012 at 11:18 | Report abuse |
    • kyle

      It is essentially applying for a job. Students send send to the programs their resume, including grades, recommendations and the programs review those, and call the students to interview. The students have to fly all over the country to interview on their own dime, then the schools rank those they chose to interview. When the match comes the students and programs both have a ranked list and the program takes all of the programs and all of the students and fits them together. So if a program got a lot of applicants, but the applicants all ranked the program low and got accepted into another place, then there is an unfilled space. Not every doctor WANTS to be a urologist, not every doctor has the freedom to move across the country and live in outback Idaho. This guy was a surgeon, there isn't a ton of surgical residencies available so programs try to accommodate by saying well, we don't need more then one surgeon and one resident per surgery, but we'll accept more 1st year residents and they can watch, so they have a preliminary 1 year spot, where they can learn and get paid even though they cannot finish there unless a spot opens up.

      March 16, 2012 at 11:43 | Report abuse |
    • Emma

      It's everything - grades from your first two years of med school, class rank, board scores from Step 1 (taken after second year), grades from third year of med school (which counts as much as Step 1 and the two of them count the most), then grades from fourth year as well as your second set of boards (Step 2), and your performance during audition rotations, where you go to different hospitals and rotate with that specialty for a month. You submit everything and residency programs decide whether or not they want to interview you. If they interview you, then you can rank them on a rank list in order of preference. The programs also rank the people they interview in order of preference. Then the computer matches everyone up.

      March 17, 2012 at 02:00 | Report abuse |
  10. John Q Public

    This is yet another "poor me" article by MDs who typically make a ton of money when they are done.

    Does anyone realize that of all the PhD level scientists who graduate less than 80% will become scientists, because there aren't enough positions for them.

    Medical school is a HIGHLY regulated industry, they never have the problems scientists have. MDs are complaining about insurance rates, too bad. Try being a scientist for a change.

    March 16, 2012 at 11:02 | Report abuse | Reply
    • kyle

      A PhD research biologist has different "problems". Yes there are few academic positions which are highly sought after, and there are industry jobs they can go into if they want, they have the same problem as every other highly educated person. They have a hard time getting into graduate school, but medical students already have that problem just getting into the school, this is essentially going through the same problem TWICE, and on top of that graduate schools mostly defray the cost of attending, where medical students typically have $300k in debt that is virtually impossible to pay off if you don't finish. This article is talking more ideally about the US needing doctors, having doctors who are qualified but simply not enough finishing schools to fill the need. The problems are WAY more varied and medical malpractice insurance is just one of the many unique problems doctors face that no PhD has to deal with.

      March 16, 2012 at 11:51 | Report abuse |
    • joeT

      It takes getting a Job for MD's to make money. Last i checked MDs don not automatically receive a check upon graduation. What most do receive is a bill for their first loan payment, and most Medical school grads have massive loans...trust me, i know.

      March 16, 2012 at 12:05 | Report abuse |
    • Alan S

      John: What you are overlooking is that medical students and medical school graduates are very special people, and the rest of us should do whatever we can to make sure that the new M.D.'s get very lucrative jobs, and we should all pay them the vast respect they are due. They should never have to worry about anything - least of all income, which should be in seven figures for all doctors.

      March 16, 2012 at 12:21 | Report abuse |
    • DrK

      @ Alan

      Way to hyperbole. Nothing of the sort was said but leave it to someone to exaggerate the issue out of proportion to the points being raised. Anything constructive to add to the conversation?

      March 16, 2012 at 12:42 | Report abuse |
    • E

      At least MD's have a strict vetting system for practice.

      The quality for PhD's is extremely varied. I've encountered PhD's dumb as bricks. So much for qualy's.

      Plus, once a PhD does get established as a tenured professor, it's nigh impossible to remove him/her short of a scandal. In other words, these people get a far better job security in the long run.

      March 16, 2012 at 13:27 | Report abuse |
  11. bob

    And who wants to go back to the days of plain old meat/potatoes/vegetables, when we have all this GREAT food and service now which is only available BECAUSE of the great RestaurantAid program?.... I don't blame people for wanting to just socialize the government, I shudder to think of what it'll be like without my fancy French omelletes for breakfast anymore...

    March 16, 2012 at 11:02 | Report abuse | Reply
  12. AmadoC

    The hell, he's already a surgeon.. his diploma has an MD on it... you said it yourself. When someone is dying, under God and under your own oath as a full American, you are commiting a crime by not allowing Sam to perform emergency surgery to a victim. How well Sam performs, and what God chose for him to accomplish that day and at what extent, and if because he will not receive credit.. it is because God has better things for Sam.. and no matter how many times he tries... he was ment to be slicing-off wings in heaven for men to fall on Earth. Sam keep it up! Let the fat pork-oil hogger choke, since he declines your MD.

    March 16, 2012 at 11:04 | Report abuse | Reply
    • Katie

      No, he's not a surgeon yet. He's a medical doctor. He has not yet been trained to do surgery.

      March 16, 2012 at 11:49 | Report abuse |
    • kyle

      Actually he came from a foreign medical school so yes he is a surgeon already. He just isn't qualified to work in the US until he completes a residency program here to make sure he is up to snuff. It is like being in a PhD program in a US school and wanting to transfer, all schools require like 30-60 of your credit hours be from that school which you are graduating from. So you can't do all your work at university of mississippi, grab your dissertation and research notes, transfer over to harvard on graduation day and be like "TADA" I'm a harvard graduate.

      March 16, 2012 at 11:55 | Report abuse |
    • jonmd

      no, even he's not yet a surgeon. even from a foreign country. The medical school training gives the MD degree but does not (in any country) allow you to get a license to practice medicine. Not until after (at least part) of residency training

      March 16, 2012 at 13:25 | Report abuse |
  13. NJBob

    This country has plenty of money for war but when it comes to health care for its citizens, well, sorry, there's no money for that. Anyone who can defend such a situation is morally bankrupt.

    March 16, 2012 at 11:04 | Report abuse | Reply
    • Katie

      There's not even enough money for war. We have to borrow it from China, and depend on independent companies to pick up a lot of the slack.

      March 16, 2012 at 11:50 | Report abuse |
  14. mike

    woohoo! match day is today, good luck fellow students, not matching is a nightmare and you must realize that u.s. residency programs are funded by taxpayers, thus international students fare far worse than americans, also the cost of there tuition is often significantly less than american medical students tuition

    March 16, 2012 at 11:06 | Report abuse | Reply
    • Notzo Old

      Fail. Needs more classes in logic and English. "there" tuition?

      March 16, 2012 at 11:59 | Report abuse |
    • E

      at least his time will be more worthwhile taking care of patients than yours as a grammar nazi.

      March 16, 2012 at 13:35 | Report abuse |
  15. DefBea

    I aspired to be a surgeon when I started college some thirty years ago. I am quite blessed because my rehabilitation councellor (I am a traumatic brain injury survivor and deaf) helped me conclude this was not a realistic career goal for me. While I was dissappointed at the time; I later realized this did not make me a "failure." I changed my major and moved on. Looking back, I see the value of my councellors guidance. Yes, I could have spent years and hundreds of dollars chasing that dream and still not reached the goal. Sometimes I beleive we all lack appropritiate guidance from our parents, educators and mentors early in our academic careers. I was simply the "lucky one."

    March 16, 2012 at 11:07 | Report abuse | Reply
    • DefBea

      That should have been hundreds of thousands of dollars.....

      March 16, 2012 at 11:09 | Report abuse |
  16. gooddoctors

    forget this dumdum article.
    you really want a doctor treating you with a c- grade average?
    get real

    March 16, 2012 at 11:11 | Report abuse | Reply
    • AmadoC

      Supposedly it's called a chicken-scratch signature, and it's in demand. LOL

      March 16, 2012 at 11:16 | Report abuse |
    • NJBob

      I don't want the carpenter who is working on my house to have a C grade average either. What was your grade average?

      March 16, 2012 at 11:17 | Report abuse |
    • Notzo Old

      Hey, this is America. An utter doofus with a C-average from Yale can be President.

      March 16, 2012 at 12:01 | Report abuse |
    • Katie

      If you look at it that way, you're going to have to learn to do a lot of things yourself, aren't you? Why the emphasis on grades?

      C students include President GW Bush, Sarah Palin, Senator McCain (who graduated dead last at the Naval Academy). College drop-outs include Bill Gates, Glenn Beck, and Warren Buffet.

      March 16, 2012 at 12:02 | Report abuse |
    • Right Wing Hooey

      There was an old saying when I was in medical school in the '80's that's probably always been around:

      "C =MD"

      You just have to pass to get the degree. But then you won't get a residency spot worth a hoot with a 'C' average.....

      March 16, 2012 at 12:18 | Report abuse |
    • kyle

      C=MD refers to the pass/fail policies of medical school. If you score a 75% on a test in medical school you still pass the course and when you graduate you still have the same diploma as the rest of the students. If you think these "C" students are bad/stupid/lazy then you are simply ignorant. These students already required to be in the top 10% of their undergraduate classes as well as typically scoring in the top 10% of the entrance exam (MCAT) just to be accepted into medical school. The term also might indicate the tendency of parental income to have an influence on placing into medical school, but thats true of all the ivy league schools as well.

      March 16, 2012 at 23:03 | Report abuse |
    • Emma

      Where does it say he had a C- grade average? Have you been to med school? If not, I don't think you're qualified to discern the intelligence or ability of anyone with any kind of average.

      March 17, 2012 at 02:45 | Report abuse |
  17. danny

    To the few people on here complaining that doc earn too much....if you calculate their actual hourly rate and compare that to other skilled professions, I think you will see that they aren't really doing that well.

    March 16, 2012 at 11:17 | Report abuse | Reply
    • derek

      that is correct!!

      March 16, 2012 at 12:41 | Report abuse |
    • E

      factor in the debt amassed from loans and the potential income deferred for training.

      you'd wonder why any of us went into medicine.

      March 16, 2012 at 13:37 | Report abuse |
  18. Rob

    The only thing worse than a good foreign doctor not being able to match is a really bad foreign doctor who does match. I've seen both cases, and the damage that a really bad resident can do to a residency program can last for years.

    March 16, 2012 at 11:22 | Report abuse | Reply
  19. Logan

    I'm going to make a prediction. Democrats reading this will blame it all on republicans. Republicans reading this will blame it all on Democrats. No one will make any suggestions on how to actually improve the situation beside voting the other party out of office. The problem will go on and the process will repeat itself until enough unresolved problems have mounted to a point where out nation collapses.

    March 16, 2012 at 11:24 | Report abuse | Reply
    • Newmoon2

      I think you've hit the nail on the head. Finger-pointing has become the national sport of choice. Kind of sickening when everyone's long on blame and batting ZERO on solutions.

      March 16, 2012 at 11:51 | Report abuse |
  20. rose

    never say never.

    March 16, 2012 at 11:25 | Report abuse | Reply
  21. Matt

    Doctor Youn:

    I am a little confused here. So you, (the author) are a doctor and you appreciate the work being done by "Sam." You right the following "I watch Sam meticulously clean and rinse the surgical instruments, his hands moving steadily and purposefully. There is not an ounce of unused motion. The fluidity and grace in his hands remind me of my surgical mentors. Then the sad realization hits me. It doesn’t matter how much Sam wants it. He will never be a surgeon."

    I have a better idea. How about you offer Sam a residency or even recommend him to one? I think you ended the article a little abrupt by saying he will never be a surgeon. That isn't the kind of encouragement you would expect from someone in the medical field. You felt so compelled to write an article for CNN about the challenges medical students face after school, more specifically, about one individual, yet what are you doing to help the situation? Instead, you end the article with no hope.

    Just my two cents.

    March 16, 2012 at 11:27 | Report abuse | Reply
    • Crocky

      Maybe because it doesn't work that way. THE HOSPITAL WITH THE RESIDENCY PROGRAM has to offer "Sam" the residency and it's done through the clearinghouse. Individual doctors don't have a say in the process per se.

      March 16, 2012 at 12:13 | Report abuse |
    • danny

      your comment is stupid, Dr. Youn can't "offer him a residency".

      March 16, 2012 at 12:15 | Report abuse |
    • E

      The ACGME and state medical boards wouldn't honor Dr. Youn's offer.

      They wouldn't certify "Sam" to practice, and therefore that proposed solution is a colossal waste of effort.

      March 16, 2012 at 13:10 | Report abuse |
  22. Another Surgeon

    I found this article interesting, but I found the comments even more so. I think the author could have made his point a little better, but here are some facts. There is not just shortage of doctors in this country, there is a shortage of surgeons. While Sam could probably easily pick up a family pratice or internal medicine slot, that is beside the point. We currently have a shortage of surgeons in this country (both general and subspecialty trained) and we have only expanded the number of general surgery residency slots by 30 slots over the last 5 years. There are approximately 1500 general surgery residency slots open each year and they all fill, mostly with American Medical graduates. We need to expand the number openings if we are ever going to close the gap in the number of surgeons needed and the number available. This is a real issue and is being addressed by ACGME but it costs money to have residents. For the record, residents can't bill for services, So they do not make money for hospitals as providers. Most teaching hospitals are not for profit, so they are not flush with cash. It is costly and difficult to start or expand a program. I do think the government may need to look at this problem because eventually there may not be a trauma surgeon to take care of you after your car crash or a general surgeon near by to take out your appendix.

    Also, it is a common misconception that only the bottom students do not match. I actually have very good test scores, graduated near the top of my class and didn't match. That was my fault. But I did scramble into a preliminary spot then moved on to a permenant spot and now I am in practice. Some of it is persistance, but some of it is education.

    Finally, foreign medicals schools are not all second or third tier. Many are, but if you graduate from any school not in the US or Canada (same regulating body) you are at a disadvantage. You could graduate from a English medical school at the top of you class and you are still at a disadvantage in the US match. There are many reasons for this, some are a true bias (it was often quoted when the program made its match list that we did not accept IMG) and some of it is practical, like when your intern can't start because they had problems with a visa.

    In the end, there is a very real shortage of all types of physicians which needs to be addressed at both the medical school and residency level. IMG are a different issue. Some IMGs are highly skilled and would add value to the US that are not working. Other are working here and are a drain on the system. These are two issues and should be addressed separately.

    March 16, 2012 at 11:28 | Report abuse | Reply
  23. gggg

    So, they've increased the number of medical schools and medical graduates. But, there is no corresponding increase in people in the residency program? Let's say that means 5000 more doctor graduates. With no new residency programs, it does not matter if that 5000 got straight A's, it only means there will be 5000 more unmatched MDs(12000 instead of 7000). What it really means is that, though we may need more doctors, we won't get any more. Just more graduates. Did congress come up with this stupid plan?

    March 16, 2012 at 11:28 | Report abuse | Reply
    • gooddoctors

      these leftover graduates are most likely bottom of the barrel with bad grades. who really wants them? you want a doc with a c- grade average?

      March 16, 2012 at 11:31 | Report abuse |
    • Emma

      gooddoctors, quit repeating inaccurate information!!! It's been posted numerous times now that you're wrong and so anyone else who follows that line of reasoning. There is no bottom-of-the-barrel and the majority of those who are unmatched are NOT C-average students.

      March 17, 2012 at 02:51 | Report abuse |
  24. Not All Docs Play Golf

    To Sam: As a physician practicing primary care internal medicine, and driving a 13 year old Chevy, and who at age 53 lives in neighborhood where my two next door neighbors are a high school teacher and a fireman, and as someone who basically traded in his youth for this career, I say, please, Sam, forget any delusions about medicine being a great career. Stick with waiting tables, where you won't get sued if you happen to make a mistake on an order. Not that medicine doesn't have it's moments, it does. But my advice to you, Sam, is to forget investing any more time in a medical residency, and go do something much easier for a better living.

    March 16, 2012 at 11:30 | Report abuse | Reply
    • Pain Doc

      You, are right on the target with that. I agree. I'm a 46 year old surgeon, and I will not support my 10 or 12 year old in any decision to go into medicine. The trial lawyers and insurance companies have ruined it.

      March 16, 2012 at 11:57 | Report abuse |
    • Newmoon2

      I'm sorry you don't find your chosen career as 'rewarding' as you thought it would be. Ironically, you probably have more in common with your neighbors than you think. I doubt they find their careers as rewarding as they had thought they would be. Funny how reality often falls short of our youthful expectations. That said, if you are that discontent I doubt your patients are getting the quality of care they had hoped for, too. A sad situation all the way around.

      March 16, 2012 at 11:59 | Report abuse |
    • Newmoon2

      Question to you and Pain Doc – would you support a single payer (universal healthcare) system if it meant significant changes in the malpractice situation?

      March 16, 2012 at 12:03 | Report abuse |
  25. Jim

    It really is too bad. I know several doctors from Russia that are very capable. Their med school education is just as good as here and they would be great additions to help out with the shortage in the US but there just aren't enough residency programs to accommodate them so they can't practice. Adding more subsidized residencies with some service requirements, i.e. GP in rural areas or poverty areas, would go a long way to alleviating some of the problem.

    March 16, 2012 at 11:33 | Report abuse | Reply
    • Jim

      I should add, they have done their residencies in Russia and have been successful practicing doctors for several years. When they want to move to the US they are required to pass English proficiency exams, board exams and do a residency in the US.

      March 16, 2012 at 11:35 | Report abuse |
  26. coder

    as long as we continue to profit off of human suffering

    we all suffer

    medical care should be a right of citizenship – not a matter of greed

    March 16, 2012 at 11:33 | Report abuse | Reply
    • Right Wing Hooey

      WRONG answer McFly !!!!!! With no profits at all, how are you gonna pay your nurses, buy supplies, pay $100,000 a year for malpractice insurance, pay rent for an office, pay for continuing medical training required to maintain a professional license, pay the light bills, the taxes on your practice, give raises to your employees, etc., etc, etc??? Oh, I forgot, Obama will just soak the rich and pay for it. Sorry.

      March 16, 2012 at 12:13 | Report abuse |
    • Right Wing Hooey

      WRONG answer McFly !!!!!!

      With no profits at all, how are you gonna pay your nurses and employees, highly trained technicians, buy supplies, pay $100,000 a year for malpractice insurance, pay rent for an office, pay for continuing medical training required to maintain a professional license, pay the light bills, the taxes on your practice, give raises to your employees, much less your own salary, etc., etc, etc??? Oh, I forgot, Obama will just soak the rich and pay for it. Sorry.......

      March 16, 2012 at 12:14 | Report abuse |
    • Doctor

      Who do you suspect will work for free? If average medical school debt approaches $200,000 how do we entice any intelligent, hardworking people to do the job for free?

      March 16, 2012 at 12:39 | Report abuse |
    • Andrew

      Here Here.

      March 16, 2012 at 12:41 | Report abuse |
    • E

      In an ideal, majestic world with infinite resources, that would be true. I would personally support ideal.

      Problem? Finite world, finite resources.

      March 16, 2012 at 13:42 | Report abuse |
  27. common sense

    As Rick Santorum said – College, including medical college is for snobs. We "hard working" Americans need no college education.

    March 16, 2012 at 11:51 | Report abuse | Reply
    • Carl

      Darn tooten! I can be one of them thare surjens! Ain't needen no coleege edyoucashun.

      March 16, 2012 at 12:10 | Report abuse |
    • toxictown

      You betcha! I can patch up my ol' pickup and I'm sure I can patch up you! Don't need nun of them fancy college boys!

      March 16, 2012 at 13:19 | Report abuse |
  28. ROLLIN SD

    [youtube=https://www.youtube.com/watch?v=0CzLCu0Z46I&w=640&h=360]

    March 16, 2012 at 11:53 | Report abuse | Reply
  29. CGDoc

    So this matching requirement includes General Practice or Family Practice? What if the person is willing to serve in an underserved area/rural community? Makes no sense!

    March 16, 2012 at 11:56 | Report abuse | Reply
    • kyle

      Doesn't matter if they will work in an underserved area, underserved areas are not likely to have residency programs.

      March 16, 2012 at 23:09 | Report abuse |
    • Emma

      Residency is about training. Do you want an untrained and unlicensed doctor to serve the underserved?

      March 17, 2012 at 02:53 | Report abuse |
  30. Carl

    So...who wants "SAM" as their surgeon, especially after learning that test scores play a role in getting a residency?

    March 16, 2012 at 12:07 | Report abuse | Reply
  31. DBrock

    So an MD from Eastern Europe is the same as an MD from America? They go to school at age 16 and graduate from med school at age 21. Whereas in the US, students graduate at the earliest by age 25. The author mentions nothing about how qualified these foreign applicants would be. Are they able to communicate to patients effectively? How are their board scores compared to US applicants? I can't believe the author left that part out.

    March 16, 2012 at 12:09 | Report abuse | Reply
  32. Obama

    Wait...it's not FAIR that he doesn't have a position. Let's make one for him since everyone should be equal.

    March 16, 2012 at 12:14 | Report abuse | Reply
    • asdf

      The argument has nothing to do with fairness – did you even read the article? It's about how he should be a physician because we need physicians. He didn't even suggest letting him in without training him – he suggested more residency positions to create more doctors. If you were so interested in limited government regulation, this guy should be allowed to practice on his own with no licensing! Problem solved!

      March 16, 2012 at 12:40 | Report abuse |
  33. Brian

    Sam didn't match – womp womp. Medicine pre-residency is a meritocracy. Sam may have an M.D., but his USMLE scores probably weren't up to snuff for the programs that he wanted given his foreign medical education. Yes, the bar is higher for foreign medical grads applying to U.S. residencies, but there is no U.S. body for overseeing foreign medical education. Additionally, if you attend a medical school in the Caribbean the necessary MCAT scores and GPA, aka the barriers to entry are much lower. The bottom line is that desire and ambition in this instance must be accompanied by high achievement.

    March 16, 2012 at 12:17 | Report abuse | Reply
    • kyle

      Brian, if a caribbean medical student gets the same grades on his step exams does that not indicate that his education was equal to the US student? Thus having residency programs that are not offering these students is nothing but old fashion ego, which in the medical profession is standard fair.

      March 16, 2012 at 23:14 | Report abuse |
  34. NorCalMojo

    Looks like he chose the wrong degree.

    March 16, 2012 at 12:20 | Report abuse | Reply
  35. Dan

    There is a huge disparity between the viewpoints of the people who say there is a doctor shortage and that of the politicians.

    Let's say for a given area whoever says there is a shortage of doctors says there needs to be 50 more.
    Those 50 doctors will need to work with an established "health care corporation" or work in private practice. Private practices do not have the resources to teach interns, so "health care corporation" it is.
    But the health care corporation needs to expand its facilities to accomodate the 50 additional doctors in training.

    Here's where the polticians come in.
    In order to "provide quality health care", governments have established the process of "statement of need". A facility files a statement of need with the state medical board stating that provision for 50 more doctors is needed.
    The politicians have decided that, "in order to provide quality health care", the number of beds in facilities, thus the amount of revenue for the facilities, thus the number of doctors that can be paid by the facilities, gets limited.
    "After all, too many choices leads to questionable decisions and results in shoddy care." (Almost a direct quote from this state's medical board)

    So, although there is a real shortage of doctors, the states have severely curtailed the opportunities for medical facilities to train new doctors via internships.

    March 16, 2012 at 12:21 | Report abuse | Reply
  36. Zeek2012

    An "MD" from another country does not equal an American MD. Their standards, training, and schooling is vastly different and not regulated like our schools. The answer is not importing more physcians from foriegn medical schools. Sam could match a residency a be a physician but not the lucrative specialties he wants. The fact is, more regulation and stricter requirements should be made on foriegn physicians as well as the Carribean students who failed to gain acceptance in America and paid big bucks by a shady school in the islands. These people will be treating your illness. There is more to cranking out physicians than reportedly granting residencies to everyone with a "degree" from a foreign school.

    March 16, 2012 at 12:24 | Report abuse | Reply
    • kyle

      Lol, if those shoddy students are able to pass the basic medical knowledge step, the clinical skills step, and the clinical knowledge step with the same scores as a US student then I would say they are as good and deserve as much of a residency slot as any US student. I want a good doctor, not one who's daddy's contribution to the school got him in.

      March 16, 2012 at 23:18 | Report abuse |
  37. Atomico

    To save medical school graduates, readers are left to support Obama's healthcare plan that would further deepen national debt under inefficient medical care system.

    This system has already been in place in Canada. Canada has a chronic problem with its costly and inefficient healthcare system.

    March 16, 2012 at 12:33 | Report abuse | Reply
    • asdf

      The vast majority of people in Canada love their healthcare system, and they spend a fraction of what we do.

      March 16, 2012 at 12:37 | Report abuse |
    • Andrew

      "Canada has a chronic problem with its costly and inefficient healthcare system." ... Right whereas America is highly efficiency and low on costs.

      March 16, 2012 at 12:40 | Report abuse |
    • Atomico

      @ asdf: That vast majority is not at the receiving end of the healthcare system. This majority is left with believing in the stability of the system that continues its costliness/inefficiency and lack of innovation.

      Tax payers money goes to (1) its military and (2) to healthcare system.

      Why do citizens need to pay so much tax for a costly system? No need really. Only to pay highly educated people and politicians. I'm warning against Obama's similar track path in America.

      March 16, 2012 at 12:42 | Report abuse |
    • Atomico

      @ Andrew: You forgot how little tax you pay compared to Canadians.

      March 16, 2012 at 12:43 | Report abuse |
    • asdf

      right – you would pay more in tax, but get a more efficient healthcare system that costs significantly less. Medical costs are the number one cause of bankruptcy in the US every year (except 2009, which was foreclosure). In a system that runs more efficiently, you would get more out than you get now for less costs than you pay now.

      March 16, 2012 at 12:50 | Report abuse |
    • Atomico

      @ asdf – a government-run system is never efficient. In Canada, it has led to a chronic problem of increased costs. This trend is expected to get worse, especially with retiring baby boomers.

      Perhaps you're referring to non-governmental efficient system. I'd contemplate this option if it doesn't reflect the same attributes as a government-run system like in Canada.

      March 16, 2012 at 13:01 | Report abuse |
  38. asdf

    One of the biggest problems with the medical school system is costs. While the gov. will loan you the money for it, they don't pick up any of the tab, and medical school costs around $50k per year just in TUITION! Throw another $15k at least for living expenses, because most teaching hospitals and medical schools are in cities. Then, for four or so years after med school you only make less than $50k per year, and still have to support yourself and maybe a family because you're almost 30 now.

    The other huge problem with this system is that primary care is the field we need to fill, and nobody is doing it. That's because primary care pays peanuts compared to specializing in something. This bites us again on the back-end because its cheaper to treat someone at the primary care phase, before their problem worsens.

    March 16, 2012 at 12:37 | Report abuse | Reply
  39. jmp38

    MD is apparently becoming just another expensive lottery ticket, just like the JD, MBA, and PhD already are...and let's not pretend that winning the lottery is a function of merit...it's a function of who you know and how good you look at that 10 minute interview.

    March 16, 2012 at 12:47 | Report abuse | Reply
    • Atomico

      I agree with you. I would add that MD, JD, and PhD's are service-oriented designations. Unless the economy picks back up, all service-sector jobs are becoming a lottery.

      You'll no doubt see a trend in MD/JD/PhD waiters/waitresses until the economy recovers. It's a sad trend in developed countries where most of its economy is service-sector based. This would not have happened in an economy that has a balance of labor and service, each with specializing trades that require more education.

      March 16, 2012 at 12:55 | Report abuse |
  40. Dwyse1

    I can see the political affiliation all over these writings. Republican’s regurgitate what they have been told, belittle the research and pull partial statements and use them as weapons. If you don’t agree with them you are being “political” . I do not understand why Republicans are against Obama, he has given them everything they ask for, Obama care was a Republican bill in the 80’s and Mitt’s bill in his home state. They claim to not want government involvement and then they want to pass bills to limit oil companies high profit sales to foreign countries. We have a crisis in health care, and our politicians don’t want the public using their “socialists” government healthcare system. WE NEED MORE Doctors! There are excellent examples of what can resolve the problems but who is listening?

    March 16, 2012 at 12:48 | Report abuse | Reply
  41. Carl R. Noback, M.D.

    Dr. Youn presumes, erroneously, that all residency programs use the Match program. Quite a few residencies accept applicants at other times (i.e., quarterly) outside of the Match. Some select their prime applicants outside the Match and then use the Match to "fill in the gaps".

    It also needs to be pointed out that Year 2 spots do not go through the Match. There is no need to "re-enter" as Dr. Youn suggests.

    An old joke needs to be remembered:
    Q: What do you call the person who graduates last in their Medical School class?
    A: Doctor.

    The simple fact is that obtaining a degree does not automatically confer employability IN ANY FIELD. Ask the thousands of unemployed engineers, or English majors, or... you get the point. Why should medicine be any different? Why should a FMG (foreign medical graduate) assume job placement in whatever he wants in a foreign country?

    Residencies are controlled by the Specialty Boards and the ACGME. Desirable residency slots have ALWAYS been in short supply. One may not always get the position one wants. US citizens are guaranteed life, liberty, and the pursuit of happiness. Attaining happiness is NOT guaranteed.

    March 16, 2012 at 12:49 | Report abuse | Reply
    • Bob

      Well said. As a non-doctor, I applaud you.

      March 16, 2012 at 13:01 | Report abuse |
    • Emma

      I'm sorry, but can you cite a source? The vast majority of residency spots are filled in the Match. The very, very few slots that are open are open for a couple of reasons - either they fired someone from residency so a spot opens up, they didn't fill in the first place, or someone quit. If you're talking about pre-matching, that will no longer be allowed next year.

      March 17, 2012 at 03:00 | Report abuse |
  42. blonde airhead

    My advice is quit school and marry rich

    March 16, 2012 at 13:09 | Report abuse | Reply
  43. Luterinho

    This has nothing to do with market or gov't. The shortage of doctors is an "artificial" number. True, the reality of attending and completing a medical degree is long and difficult. The ability to practice medicine is a long, expensive, and difficult path that few has the means and will-power to complete it. Still, there is a greater reality that creates and manipulates this "artificial" shortage of doctors. The shortage of doctors is really a "artificial" shortage that is both fixable with more financial resources and also with the elimination of AMA, whose lobbying has created this artificial shortage to inflate the cost in medicine by keeping the supply number of physicians artificially low. It is hard to argue against the very professional community that function is to help in our health. But people needs to wake up because this shortage has nothing to do with market or gov't, but more to do with AMA lobbying power to restrict the number of doctors entering the medical field. Read | http://alturl.com/riwya

    March 16, 2012 at 13:14 | Report abuse | Reply
    • kyle

      While the AMA is part of the problem it is the entire US system that is at fault. It is the unhealthy society that wants to live anyway they want and then have a doctor fix them. Its the insurance companies that are trying to profit off of an unhealthy societies health care (seems mind boggling). It is the legal system that awards massive payouts in almost every settlement. Then you have the patients who want doctors to be perfect in a biological system that is so varied and messy that it is impossible to not have problems, and Doctors who think all the mistakes leading up to their ridiculously expensive malpractice insurance is the fault of all those other doctors but not them. Everything has flaws in it, but there are ways of fixing each of the problems and we simply need politicians and doctors that are willing to fix them.

      March 16, 2012 at 23:32 | Report abuse |
  44. toxictown

    Sam should look into becoming a mad scientist (a growth industry). He could set himself up on an island (preferably shaped like a skull) and conduct fiendish medical experiments (preferably while cackling hysterically) thus putting that medical degree to work!

    March 16, 2012 at 13:16 | Report abuse | Reply
  45. Jo

    Welcome to America! Loads of people who are American born and raised; have PHD’s and cannot find work. I am going into my PHD program, husband is and architectural designer and both of us are out of work. Ok, not totally out of work; we clean stalls in the heart of American’s farmlands of $10.00 an hour. American 2012; being a waiter or hostess; cleaning droppings from farm animals is all we can get. Pretty soon one will need a PHD to be a manager at a Denny’s restaurant, or a MBA to be an employee at McDonalds. We are now looking overseas to find a job. I love America, but what’s an educated city women; turned famed worker going to do? Good luck and blessings to you Dr. The 7,000 + doctors will become 15 by the end of this year, and we will see who get's what.

    March 16, 2012 at 13:20 | Report abuse | Reply
    • E

      PhD in what?

      For all we know, you could have a PhD in the migration patterns of the bonobos or the sneezing patterns of King Henry VIII.

      Interesting? Yes. Useful much in itself? No.

      Now a PhD in bioterrorism on the other hand ...

      March 16, 2012 at 13:50 | Report abuse |
  46. Fezzywig

    Maybe "Sam" should stick to practicing medicine in his own country.

    March 16, 2012 at 13:25 | Report abuse | Reply
  47. Neviana Dimova

    Since my citizenship interview and test, I have been reading the Declaration of Independence which identifies our inalienable rights as life, liberty and pursuit of happiness.

    For the majority of physicians, pursuing happiness means practicing the profession they sacrificed so much to train for. Year after year more International medical graduates, who are US citizens and permanent residents are denied residency positions that lead to initial board certification, in favor of visiting doctors training at US taxpayers’ expense.

    We are a group of 340 residency ready physicians who are not asking for any special treatment, just an equal opportunity to compete for positions in US residency programs.

    Some of our members have been trying for many years to work in their specialties. Instead they are wasting their training and talents working as lab technicians, or even pizza delivery boys, cab drivers, and Wal-Mart cashiers, just to make a living for themselves and their families, instead of helping to alleviate the physician shortage.

    Our proposals are:

    1. Give preference in residency positions to US graduates, then IMG who are US citizens/Permanent residents and if any slots are left, distribute for J1 and H1 visas.

    2. Allow IMG’s to take fourth year rotations in medical school s to acclimate IMG’s to US standards of practice and medical culture. With their extensive training and varied backgrounds they we would be very valuable interns in any hospital.

    3. Insist that the programs in the residency match consider each application on its complete merit, not setting arbitrarily screening standards outside the parameters of ERAS requirements.

    4. Use federal influence to change state law as so that IMG’s who choose to, can take an abbreviated training course that will allow them to practice as physicians assistants.

    We completely support AMA resolutions:

    AMA Policies Related to Equality in Examinations for IMGs

    H-255.972 Equity in Clinical Skills Assessment for Graduate Medical Education.

    H-255.974 Preservation of Opportunities for US Graduates and International Medical Graduates Already Legally Present in the US.

    H-255.976 Speech Tests for International Medical Graduates.

    H-255.980 Foreign Medical Graduate Examination in Medical Sciences Scores not Sole Criteria for Residency Selection

    AMA policies related to promoting opportunities in residency training for IMGs

    H-310.962 Residency Programs Prejudiced Against Applicants with Ethnic Names.

    H-275.957 Changing the Grading Policy for Medical Licensure Examinations.

    H-255.934 Alternatives to the Federation of State Medical Board Recommendations on Licensure

    H-275.960 Postgraduate Training Requirements of Obtaining Permanent Medical Licensing

    H-255.991 Visa Complications for IMGs in Graduate Medical Education

    H-255.998 Penalties for Discrimination Against IMGs Seeking Residency Positions

    H-255.999 Final Report of the Ad Hoc Committee on Foreign Medical Graduate Affairs

    AMA policies related to state licensure requirements for IMGs

    H-255.982 Equality in Licensure and Reciprocity.

    H-275.935 Licensure of IMGs.

    H-275.955 Physician Licensure Legislation.

    H-275.978 Medical Licensure.

    H-275.957 Changing the Grading Policy for Medical Licensure Examinations.

    H-275.994 Facilitating Credentialing for State Licensure

    H-255.997 Alternate Licensure Protocols for IMGs

    AMA Policies Related to Credentials Verification:

    H-275.934 Alternatives to the Federation of State Medical Boards Recommendations on Licensure.

    D-275.989 Credentialing Issues

    D-275.994 Facilitating Credentialing for State Licensure

    D-275.995 Licensure and Credentialing Issues

    D-255.996 ECFMG Representation

    Physician Workforce Planning

    H-200.953 The Physician Workforce: Recommendations for Policy Implementation

    H-200.991 The Physician Workforce: Recommendations for Policy Implementation

    AMA Policies Related to Helping Underserved Communities

    H-200.992 Designation of Areas of Medical Need.

    H-200.972 Primary Care Physicians in the Inner City.

    AMA policies related to immigration policies for IMGs

    H-255.975 J-1 Exchange Visitor Program (J-1 Visa).

    H-255.971 J-1 Visas and Waivers.

    H-255.997 Fifth Pathway.

    H-255.995 Foreign Medical Graduates.

    H-255.991 Visa Complications for IMGs in Graduate Medical Education

    305.945 Funding of Graduate Medical Education

    305.981 Funding of Graduate Medical Education

    http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates/ama-working-imgs/excerpts-from-ama-policy-compendium-related.page?

    March 16, 2012 at 13:36 | Report abuse | Reply
    • Dr O

      Well said. What this article didn't state and most Americans don't know is that it's US tax dollars that pay residents. The system is flawed, thousands of US citizens, both those that graduated from US med schls, and Caribbean schls (who do their clinical yrs in the US with American students) did not match, yet programs matched people from other countries like India, Pakistan, to name a few. These people are in their countries in some cases, and are given jobs and a J1 or H1b visa, under the pretense of them going home after residency, which they never do.

      Canada only lets their citizens and permanent residents apply for residency. In the UK, Ireland and some other places, if you aren't an EU citizen, you can never get through residency. The US needs to do the same. There are many US citizens and residents from both American and International med schls who will willingly go to some of those places that these people are going to. Medicare that pays residents hold put a clause that Programs need to show that ALL US citizens and residents have a residency spot, before they can now extend it to non US citizens and residents from far places like India, Pakistan etc.

      This article had the opportunity to discuss that, but she'd away from it. For all we know Sam may be working illegally anyway and not even have a green card, let alone be a citizen.

      March 17, 2012 at 16:11 | Report abuse |
  48. Neviana Dimova

    All unmatched US citizens/Permanent Residents International medical graduates, Please join us on FB "Residency Ready Physicians"

    March 16, 2012 at 13:39 | Report abuse | Reply
  49. PrimaryCare

    IIt seems that many of the readers are missing an important point. It is not about telling Sam to go back to his country to practice medicine. It is not about giving a "free pass" to residency to everyone. It is about the fact that only increasing the number of medical students will not solve the problem of a deficit in primary care physicians. There is a bottleneck on the number of residency positions and until that is fixed we will have a real problem. Or is there a plan in 2014 when the Patient Protection and Affordable Care Act goes into full effect and 30,000,000 citizens will be looking for a primary care doctor and about 1/3 of the current primary care physicians retire?. And remember, many of those "internationally" trained MDs are in fact Citizens born and bred in the USA.

    March 16, 2012 at 13:52 | Report abuse | Reply
  50. M.

    Hire more NPs/PAs. Train them in specialty fields such as surgery, radiography, pediatrics and gynecology. Hospitals are laying off MDs and hiring more NPs/PAs. Stop medicare/medicaid fraud. MDs are quacks and beware of them.

    March 16, 2012 at 14:12 | Report abuse | Reply
    • E

      State boards still mandate that they be supported by MD's in some fashion.

      So long as human beings are involved, there will always be some conducting fraud. What makes you think NP's and PA's will be any different?

      If you think MD's are quacks, don't seek them for help. You have a choice. Just promise you won't force your delusions on others.

      March 16, 2012 at 14:19 | Report abuse |
    • M.

      E. , you are wrong about NP. NP are independent and autonomous in decision making in most of states. I don't want to give you a nervous breakdown, but by 2014 all NP will be required to have DNP degree. What surprises me is that unnecessary attention is given by media and people like you to "MD" degree holders, which is in fact equivalent to any Master's level program in states. Ok, I understand it is hard to get into MD program, but so are other programs, such as Vet., MBA and Law education, which are tough to get into. A Veterinary graduate has to go through numerous anatomies to be a specialist in his/her program, but doesn't get equivalent remuneration like MDs.

      March 16, 2012 at 14:27 | Report abuse |
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