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.