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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.
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. 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. 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. 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.
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I met Sam* in the OR a few years ago. A polite surgical technician in his early 30s, we’d often chat after work.
So there is a surplus of Medical doctors in the USA... So why haven't medical costs decreased? Oh that's right, it is because a free market does not exist in medicine. There is no capitalism in medicine. Corruption and a broken government that over-regulates the industry is to blame, and to think that millions think more regulation will lower prices. Eeek.
The above and many more examples demonstrate the continued reduction of freedom in this nation and the continued decline of America...
Sadly there isn't anywhere else to go. Just because there isn't a better place to go doesn't mean we are still a great country. We're not anymore, and the longer most of America stands idle the worse it will get. Get off your butts and do something about it. I know I am trying, and sadly when I do I'm called crazy... We have no hope.
Did you not read the article? There is a surplus of medical students...not doctors.
I'm a bit confused by John M's post. What part of "medical shortage" made you think there is a surplus of medical doctors in the US? I think there might be a bit of confusion between the MD degree, and a practicing physician.
What you are referring to is practicing physicians. If there was a free market in medicine and a "surplus" of practicing physicians-then in order to compete with each other, they would have to lower the cost of care. I understand where you're coming from but there are a few points that I think you need clarified in order to understand what's going on (perhaps then, people won't call you "crazy" when you try to change things for the better).
The first is that the MD degree is like getting a college diploma...for doctors. It doesn't mean you have a job, or even the specialization necessary to treat patients (just like engineers might need to get a masters, or be "trained"), it just means that you have completed all of the prerequisites necessary to get such training, AFTER which, you can then get a job and treat patients.
With that being said-what this article is trying to say is that because of a doctor SHORTAGE (90,000 primary care physicians the last time I saw the figures), we are trying to increase the number of MDs, so that this increased number can then graduate, GET TRAINED and go help fill in these gaps in patient care.
The problem is that the number of training spots (what you know of as "residency") hasn't increased. So even though we've increased the number of people eligible for such spots, we haven't increased the number of spots themselves and thus, the trained "practicing physician" shortage will continue.
The question you should be asking is, if we know we need more doctors, and if we're opening new schools to train people to one day become doctors, than why aren't we increasing the number of spots to train these people? The reason for that was alluded to in the article above. Because there is a freeze on medicare (which pays a large portion of residents salaries), hospitals do not have the funding or the resources to open new spots for doctors in training (by degree-MD's that you would call doctors, but who, as of yet, have not learned how to treat patients). If you want to make positive change, a good change would be to stop funding cuts to medical education. Last year medical education loans became unsubsidized, so it is now more expensive to get the degree. Since there is a shortage, we should be trying to attract, not dissuade, students from joining the medical profession.
Additionally, the shortage is mostly in "primary care" doctors, as I mentioned above. Because these doctors make less than others (even though they have the same amount of loans), there is a lot less incentive for students to join the primary care field. They want to look for a job that pays off the loans they've been acquiring for 8 years of higher education.
The last thing that should be considered is that medical costs are not commodities that can be traded on the free market, as you imply above. The costs of medical care couldn't be decreased even if we did have a surplus of doctors, bceause most of the costs of care don't come from the physicians. Hospital costs, taxes, pharmaceuticals, machines-a lot of these industries DO need to be regulated, if we would want to see a decrease in medical costs.
Congratulations to all of my fellow students who received their matches today!!! Good luck in the next phase of your education, doctors.
Sincerely,
MS II
Actually, the article pointed to a projected shortage of doctors, not a surplus. That is beside the point of increased medical costs. Those are due mainly to the very existence of health insurance. It separates consumer price sensitivity from vendor price setting. You are correct, it is not free market and that is the crux of the health care inflation problem. The answer, however, can go in one of two directions. Either allow everyone to develop Health Savings Accounts and pay out of pocket, and you will see a lot of pressure to reduce prices, but also a lot of people neglecting their own health problems; OR pay everything through a Federal program – Medicare for all – that controls prices and salaries. A truly free market system will leave a lot of disadvantaged people in worse shape, while a state-run healthcare system will be the most fair. Anything we try as a hybrid will self destruct, as we already can see.
Supply and demand, the doctors come out a lot, will earn less money-nothing too. now some forces(Capitalists and Corporations) to control the supply, therefore the demand must increase tenfold earn ton money in pocket and bankrupt the system health care in the future.Accept it .
The legal profession is also not a free market system. With so many unemployed lawyers you'd think you could get better prices on legal services, but surprise! That will, divorce, or criminal defense will continue to rape your wallet for the foreseeable future. Lawyers price fix, and apparently even the starving ones don't lower their rates.
If you think the cost of healthcare is due to doctors' salaries, I urge you to read up on the subject. It has nothing to do with how much doctors get paid and everything to do with hospitals, insurance companies, and tort reform.
You mean: why do insurance companies add NOTHING to value to patient care but like the leeches they are add unnecessary cost? That is what you meant to say-right?
Having worked in the operating room as a first assistant for 28 years, i see one of the road blocks you have to consider is if you flood the market with physicians it will also drive down their salaries. Nuerosurgeons go to school for 15 years, i doubt you will find someone willing to be in school that long for a couple hundred grand. Orthopedics is 12 if i remember correctly and you have the same situation there. Most physicians are in their 30s when they are ready to practice, im sure these brilliant minds could find a better way to make money with less schooling. The liability and responsibility just wouldnt be worth the effort if you drop their salaries.
MD Student, thank you for taking time to write your reply! As someone who is currently considering medical school, and who has already completed all of my pre-medical requirements, it is good to see some concise, honest information. I hope that more funding is appropriated for medical education, more residency spots are opened for both US and international graduates, and that we can get people who would love to work as physicians into careers they dream of.
Read, read and re-read; the students that don't match are doctors but not allowed to practice, BUT are REQUIRED to repay those nasty loans. This is a convoluted mess and one in which you cannot blame an MD who cannot practice unless on a cruise ship.
There will never be capitalism in medicine. For capitalism to work, there has to be a point at which people will not buy the service. If you are sick or dying, are you going to say, "too much"? And if someone is sick, hospitals can't refuse to treat them if they can't pay. So there is never an incentive to be efficient. People will pay whatever they have to, and if they can't the government will.
As much as everyone- particularly Republicans- hate it, the only way to fix this mess is to do like every other industrialized nation and go to socialized medicine.
Face it, people, the medial insurance industry is a huge bubble that WILL eventually pop. And probably take a lot of insurance companies with it.
The market will not, and can not, bring down costs in healthcare as long as we are paying for treatments rather than outcomes. The market will always develop new and greater innovations in the areas that make money. Cosmetic surgery, pleasure related medications, high tech expensive devices or repairs. The market (ie: the average healthcare consumer) doesn't always want, at the point of purchase, what will actually bring them better health. They want the quick fix or a high tech fix. Healthcare will never be market driven because the consumer wants and demands the impossibly expensive... health without responsibility.
Why is our healthcare system failing? Because of Medical Insurance (rating & underwriting and claims practices), Pharmaceutical Companies (profits), Provider Networks (contract physician prices down -forcing subsidization from non insured patients), Medical Equipment manufacturing and sales (overpriced equipment -how much is a surgical mallet?), medical and pharmaceutical patents (everything is patented so the company can charge what they want and we have to pay or go without). THOSE are the cause of our problems. Government intervention?! The government is representing US!
Please don't forget that Sam left Eastern Europe where he had subsidized tuition and likely no student loans. If he really wants to practice, he could find some place in this wide world to practice.
Are you a nut? My sister-in-law has been trying to get matched for 3 years now and that's after 4 years of passing the USMLE tests for international students.
We're asking international students with a degree to give up 10 years of their lives with a 50% of failure. For what purpose?
Why don't you find a job somewhere else, America needs doctor who care!
Dr B,
I agree with you. Fortunately, the weight of education outside of the US is generally lower than here. I hope he can keep his yes open. Many countries have need of surgeons... If he loves the profession, there is more than enough room to practice. If, he has vested interests here though (Family)... it might be a bit harder...
Perhaps internship of physicians educate outside of the US can be burdensome to the hospital. Is the quality of their education entering into an internship equal to that of American schools? The hospital still has to prioritize patient care over hand holding of foreign students.
Sam came here from another country period. If any of us tried to get jobs in Eastern Europe or somewhere else, we would have a hell of a time. We have fewer barriers for immigrants than most other countries. I really don't feel bad that International grads have a less than 50% match rate. The only reason it is that high to begin with, is that hospitals have lobbied hard to keep their supply of cheap labor (ie: Residents)
Good example of why, if you really want to study medicine internationally you need to RESEARCH the schools. Good luck if you're coming out of Eastern Europe (the education is considered "inferior" with the socialized medicine and lack of modern equipment), or Italy (no cadaver practice), or even the Caribbean and/or Mexico (which makes it seem like you weren't good enough to get into a US medical school to begin with even if you're an excellent student in med school). Better choices would be England, Ireland, Germany, or France.
Furthermore, it's well known that foreign medical graduates have to go above & beyond to get noticed in the match. Such as: more research, better USMLE scores, and straight A grades.
My best friend trained as a surgeon in Germany. She completed her residency and was ready to start practicing medicine in Germany when she came here because her husband received a good job opportunity. With her education she can practice anywhere in the EU, including an English speaking country like the UK.
A better question might be, if a qualified applicant like that comes to the US WHY MUST THEY REDO THEIR RESIDENCY? That's ridiculous. Are our standards so much higher than Germany's? There is no reason to subject these people to additional education.
doctors from places like cuba are better at low cost low tech medicine. While US doctors rely to heavily on technology like MRIs and other costly tests. While this may be "better" at diagnosis but it drives prices up and it also explains why when american doctors when they go anywhere else behave like chickens with their heads cut off. Just let foreign doctors take a very stringent test. Why must a practicing specialist from another country go through residency again?
It's not just international schools. That 95% match rate means that 5% of UNITED STATES medical school graduates didn't match. It's a tough pill to swallow to have $250,000 in loans and no job or income to pay it off after spending eight years of your life toward this goal.
MS II
Anna and OvervaluedDoctor, they MUST go through residency again because everything is different in the U.S., from laws to standard of care to malpractice. Residency isn't in place just to teach someone how to suture. It's in place because physicians need to know how to be physicians in this country. In some countries, if you suspect someone has breast cancer, you send them home and take a wait and see approach. In the U.S., if you did that and the patient died, you're liable.
OvervaluedDoctor, being a physician isn't about tests. Board exams are strictly to prove that you meet the MINIMUM competency required to be a physician. What determines whether or not you can be a physician is what you do during residency. Your board scores could be off-the-charts, but if you walk into a patient's room and don't know your head from a hole in the ground, you can still wash out of residency. It's there for a reason. Doctors need to be supervised by attendings before they're given a full license in the U.S., even if they were a physician in some other country.
In response to Anna, is not because America has much better than that in other countries, is because the kind of diseases you see, the prevalence of diseases in certain population, the way you operate, the medical system here is very different. It is necessary for foriegn grads to train the "american way" before practicing in the US.
The best medical care I ever had was in Germany, followed by Canada. The US was a DISTANT third. It is so sad that we force doctors from these countries to be "re-trained" in the sub-standard "American way" of medicine.
Our doctors are not substandard. We have of the best doctors in the world. It's our healthcare system that fails the masses. We must stop blaming our American doctors for the failure of our system before we run them out of practice and end up with NO healthcare. We must take accountability to fix our own system. We can do that through our government.
I love how this article some how makes the connection that the government has to spend more on the bloated Medicare system in order to support these doctors. This man wasn't even educated in the U.S. he immigrated from Eastern Europe probably thinking he could ride his degree to easy money here. Sam probably makes very good money as a waiter serving doctors such as Anthony Young. I bet there are people who would kill to be in Sam's position.
Not in the US there isn't. You know that a US citizen in his situation would be about 300k in debt just from medical school, do you think he could even begin to make payments on that type of loan working as a waiter? or sterilizing medical instruments?
Steve – I like to point out your presumptuous statement that he can make it rich here. Yes the man may be able to after years of working as a resident and additional training as a fellow. This is required in order to become a surgeon Don't forget during those years physicians in training start their salaries from 38K to 59K/year (this is the 8th – 10th year of residency training). Thank god – I don't have any debt after doing the MD-PhD route!
Sam is just one example. Five percent of U.S. medical graduates failed to match this week.
Emma,
you must know that this is the first year of a secondary match instead of the "scramble". There were open residency slots available, maybe not in a graduating med student's geographic ideal location or in their ideal specialty. Many of those did not match on the first round will match, maybe not into a categorical slot, and maybe not into the specialty that they would like. After one to three years of residency they will be able to gain licensure to practice and possibly transfer to the residency of their choice.
Poor babies, 50% of foreign medical students could not get a placement this year to eventually practice in the U.S.
You know, there are people starving in Africa.
In response to Adam: No one is comparing the suffering of unmatched MDs to starving children (except you)
But people that go to the trouble of getting an MD and can't match into residency do suffer a lot. To get to medical school in the states it takes 4 years of undergrad with great grades, the MCAT, a rigorous interview process, followed by 4 years of intense study at actual med school that usually involves taking out hundreds of thousands of dollars of loans. If you can't eventually get that good paying doctor job after matching a residency how are you going to pay all that back? After about 8 years of post high school study you are not really qualified to do much else. Would have liked to know if Sam went through the same vetting process in Europe?
Re. the rest of this article: As an American med student I'm glad to see this article getting written. My heart does go out to qualified, hard working foreign grads that can't match. But the article is ambiguous as to why Sam came to the US in the first place? Why can't he return to his country to pursue medicine there? A lot is left out that would color the situation differently.
First of all, like the post from Jody, get a grip no one is comparing anyone to starving people in Africa. And to be clear there are people starving all across the globe not just Africa. Nevertheless put yourself in their situation where you gave up 8 years of your life to work incredibly hard at a shot of something you dreamed of only to know that since your degree is foreign its equivalent to tainted blood in the states. Eight years is a good junk of someones life to dedicate to any field and to not have the opportunity to learn further and practice in a field you spent so much time learning about it is sad. Not to mention the amount of debt you collected in those years then to have to work at a job you were destined to do just to pay that off. There are for many ways to spend the money the government has which they choose to use on bribing foreign nationals and other politicians themselves. The math doesn't add up. If there is such a shortage of doctors and a shortage of residency spots why would they increase the amount of new medical schools when they will have no hospital to place these students in for training. It's flawed. The whole system in this country is flawed. Those who wish to do good by society get placed on the back burner and those who can further corrupt this nation get all the resources they need to further advance in their goal. That's the reality of the situation. And I hope and pray that come 2014 I'll match in a field of my choice even with my foreign medical degree as an US IMG. If I'm smart enough to pass the board exams let alone if any one is able to pass the licensing exam then they all deserve a shot. If you train them you will bring out the best of these medical graduates. Don't let their knowledge go to waste.
What were the statistics for US-citizen IMG's who participated in the match? Same as the overall IMG rate?
This is outrageous.
There's a reason "Sam" didn't make the cut. He couldn't match the potential of the other applicants.
I'd rather have a second-rate MD serviing me dinner than an incompetent surgeon cutting into my chest.
Actually, you're wrong. I don't know Sam's particular situation, but there are many qualified MDs left out of the match for various reasons. One fourth-year who didn't match this year has a 3.8 medical school GPA and fantastic board scores. She interviewed at 10 places for residency in emergency medicine. Three of those places told her she was "ranked to match", including her number one. She believed them and ranked only 6 places. Don't forget a computer matches everyone up. So, when all was said and done, these places didn't rank her as high as they said and because she believed them, she didn't rank more than 6 programs. She was fully qualified. It just went wrong. The Match is like a game of poker. You have to have your game-face on.
Same here, Emma. MSIV unmatched in EM this year. Was a ridiculously rough match for us this year, many great applicants turned away. Very frustrated. 🙁
I seek out medical advice from my local mathematician.
Surgeons are the top of the food chain in this country. Some (most) match because they're the best, but please know that other's match because of the $50K check that pop, or grandpa (emeriti) attached to the application. Doesn't mean that the alumni's kid isn't great raw surgical material – but it DOES mean that it's a slot not available to a physician of lesser means. However, there ARE other specialties and primary care goes BEGGING all the time. Everyone wants Derm or Surgical residencies – sorry, not enough slots. I recommend that new MDs look at INFECTIOUS DZ and/or GENOMICS. Both will be huge in a few years and let's not forget GERIATRIC MEDICINE as baby boomers fall apart we'll need them. However, the last three are no nearly as lucrative or glamorous as the first two. The waiter does not have my sympathy because military medicine would have taken him and perhaps given him a fellowship later on if he proved he had the goods to back up his surgical yearnings. There is always room for a good MD but one must often be creative. Underserved areas also go begging for docs each year = THAT is why there are so many J-1 Visa foreign physicians working in the US! The story was poorly done and not at all honest about what else is out there for those who 'don't match'.
You don't truly understand the story, do you? Underserved areas? Since when do underserved communities have residency programs? He can't be a doctor unless he can be a resident and he can't be a resident when there aren't enough slots. As for infectious disease, that's a fellowship AFTER a residency in internal medicine, a specialty that supposedly filled this year. Not enough IM slots either.
If you don't match there are several options you can take. Luckily I got my first choice! However, if this does not happen jus lower you expectations next yr. Gen surg was really hard to get into this yr. He should have tried for a easier residency. Also about the info regarding undeserved areas. It is usually easier to get a residency somewhere at outback blah blah (it is undeserved for a reason... docs dont wanna go there) then a big city like NYC or a state like Cali. So lower your expectations and dont go for something like derm when in cali when u just have a 190 on step...
That is both incorrect and unfair. US military medicine will not accept foreign grads (especially foreign nationals) until they are already 1) accepted into a civilian residency, and 2) US citizens. Even then, they must apply for the Financial Assistance Program, and accession is not guaranteed.
The military's medical residency programs are completely filled each year by graduates from the Uniformed Services University of Health Sciences, the Health Professions Scholarship Program at civilian medical schools in the US, and currently-serving military General Medical Officers. Bottom line: there are no military residency slots left for civilians of any stripe.
American medical training is a joke.
Doctors don't/cam't even do exams anymore. They order tests.
They could all be replaced with computer programs and
no one would notice a difference.
can't (typo)
If American medical training is a "joke," why do so many IMG's want to come here? I don't believe things have changed since I graduated from my postgraduate training in pediatrics in 1993– in fact, I know they haven't. I can still perform exams, and occasionally order tests and imaging studies. While I do agree that physicians who trained in countries that lacked sophisticated medical technology often have more finely honed skills of physical diagnosis because they relied on physical findings, it does not logically follow that a well-trained American physician cannot perform exams. While I feel that it is difficult for physicians from other countries to repeat residency training here, I cannot see an easy alternative. There are many countries with inferior medical training, as well as quite a few countries with a spectrum of medical schools and hospitals that range from excellent to poor. Furthermore, an excellent physician can graduate from a poor medical school, and vice versa. Deciding which foreign graduate is well trained enough to practice in the US without any US residency experience would be a daunting task, especially if based solely on written and practical exams. And finally, American medical practice differs a great deal in many ways from medicine as it is practiced in many other places. I would think that a period of residency training would be essential for a foreign graduate to become familiar with the practicalities of every day life as a practicing American physician.
So if you think you have a brain tumor, you'd rather the doctor listen to your lungs instead of sending you for an MRI? FYI, there wouldn't be so many "tests" if there were better malpractice laws. Doctors have to send for tests because they're liable if they miss anything and many disease processes require imaging and labs, not just tests.
Emma- With all due respect, I'm sure you know through your years of training that you would always check the vitals of any patient that walked in your doors. And part of that in some schools is checking the patients heart and lungs. A lot of things can be picked up if a doctor performs a thorough physical exam. However what I believe Michael was getting at is that in the U.S patients are now seen as customers on a waiting line. When their number is called they go in and the doctor listens to them for about 5 minutes and sends them on their way. Only for the same patient to have make routine follow ups because the matter was never taken care of in the first place. It is now about ordering any lab work as possible. One reason of course is to see what's going on when the physician themselves have no idea. Secondly, the physician can use these lab exams as a method of further billing the insurance so they can get paid. It's become a business more than it has become about the empathy and care of a patient. Sure this blame can be explained by the fact that doctors are overworked but its becoming even more alarming when it appears as though your doctor has no care in the world as to what is going on with you. There are so many educated doctors who have the empathy and compassion for others that are unfortunately unable to practice because of the cracks in the system here in the US.
Why do fmgs come here? Money.
"So if you think you have a brain tumor, you'd rather the doctor listen to your lungs instead of sending you for an MRI?"
So you think if I go to my doctor and tell him I think I have a brain tumor he should order an MRI?
I'd like him or her to listen to my lungs as well as an exam of the cranial nerves. All of them.
Them if indicated an MRI. That would be appropriate.
Just ordering an MRI is not appropriate and done far too often.
if it's suck a joke, let's see you go through the training process. poser.
@ Micheal....right because you can obviously read minds and see what physicians are thinking because obviously all diseases manifest the same way in every person so you can just cross things off of a checklist to use process of elimination of your subjective evaluation of symptoms to diagnose someone *note my tone of sarcasm. I think you need to go to medical school then reevaluate what your opinions when you have sufficient information to have a relevant opinion.
I have also been posting as Michael, so changing name.
Michael, you are wrong about US physicians being unable to do a comprehensive physical, they can and do. However they do overuse technology fairly often. I would recommend that your read Overdiagnosed, Making People Sick in the Pursuit of Health by Gilbert Welch, MD and two other physicians at the Dartmouth School of Medicine.
Emma is correct in that many exams are unnecessary, but done to protect the physician. In the US there is an expectation of living forever. If someone dies in the hospital or nursing home, there must be someone responsible. I have traveled to other countries without the tort system we have, and people do not have the same blame game going on. Thus in spite of a lack of technology they often time receive adequate health care.
@Jamie–please educate yourself before you speak. Physicians do not make extra money from ordering labs and tests. Your primary care doc bills an E&M code which is a 5 level system based on your complexity. (evaluation & management). They do not make money for ordering labs or tests. The lab bills for it's services and the radiology department and radiologists bill for their services. A physician will bill a separate charge for a procedure in addition to the E & M charge if a procedure was done–I.e. incision and drainage, mole removal, laceration repair, etc. That is the ONLY way a physician makes money.
I agree. VERY RARELY did I see MDs listen to their patients' heart and lungs in the hospital. I'm an RN, worked in urban area hospitals, and I feel very comfortable disclosing that FACT. I was also a patient in the ER for over 12 hours and not once did an MD or NURSE listen to my heart and lungs. APPALLING how medicine is being practiced nowadays. I filed a JCAHO complaint.
My wife's oncologist here in the US is married to an oncologist who lives in the UK. Both are competent and highly respected doctors in their communities. However because he was trained and qualified in the UK and had his own practice with patients when he met her, they have chosen to maintain a long-distance relationship so that each one can continue their work in their fields. She cannot move to the UK because of her children and he cannot move to the US because he would have to redo his entire residency in the US even though he has been a practicing physcian for years. I can see the benefits of having him do a short training period under the observation of a peer mainly to become familar with US laws and practices but to redo an entire residency? This is madness.But then again, who said healthcare in the US was rational or fair?
I agree with you. Rather than making him do 6 years over (oncology is 3 years of internal medicine, 3 years of medical oncology ... assuming it is just a clinical training program, sometimes research programs are longer), 1-2 years seems reasonable for situations like this. That said, for a practicing physician, telling them 1-2 years is too much (opportunity cost just isn't worth it). In addition there is not as much need for this type of thing as you may think AND there could maybe be 2-3 programs nationwide who would be able to find the manpower to really coax completely trained FMGs through the system. It is FAR easier for them to stay in the system in which they trained.
I have a friend who practiced for a few years after residency then had a complicated pregnancy (twins) and ended up giving up her practice for 4 years to care for her unfortunately high needs children. Guess what, she can't get a license to practice now that both are 5 and starting school and she wants to go back part time. She is being asked to retrain. At most, this should be 6 months of retraining but she is being told she essentially needs to do a year of full time (residency type) training. She was a GREAT doc 4 years ago, one I'd go to. There hasn't been that much that has changed.
The story fails to point out something very important - he may never become a surgeon HERE, not a surgeon at all. This is by choice, not by luck or because of any discrimination against foreigners. You also did not mention if he would consider other specialties. Sorry, but the gist of this is that he's after the money, not the medical career.
There are few simple solutions to these complex problem.
1. Guaranteed residency spot for US Medical graduates, in other words, residency should be part of being MD. Extension of medical curriculum. This does not happen in any other profession. A lawyer becomes a lawyer as soon as he finishes the law "degree". Same should be in medicine. Seperate application, administration are all waste of time, money.
2. Training recognition or Training certification for Foreign graduates- It is done in many European countries. Outside training is either recognised fully, or partially. Many have to take tests to prove it. That is more efficient than subjective everybody to repeating training.
4th leading cause of death in the US is doctor and nurse FUps, killing 350,000 t0 400,000 per year, if you have the misfortune to require medical care, ask questions be careful and good luck.
Uh huh doctors/health care is so bad that life expectancy in this country is decreaseing..yup that makes sense (once again, note my tone of sarcasm). Your statement doesn't make sense. Try giving your numbers context say comparing physician/nurse screw-ups now to say 1900 when many people didn't have access to health care. There is more help being done than harm in terms of mortality rates.
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.
Also applying for residency program is not free, the way applying for a job is. You pay thousands of dollars!
Gosh this writer failed to explain the entire process on so many levels.
The writer's book is horrible.
Stop doctors in private clinics that usually use the name of saints to attract ignorant people, they are not even doctors only P.A. and they charge $20.00 per visit but charge you $300.00 in the end because they make you believe you need injections that God knows what they have in them. Help!!!!!!!Please investigate all those private clinics!!!!!
Hospitals trained residents long before Medicare provided additional subsidies for that purpose. How about if hospitals pay the residents their market value?
When my great uncle trained (1950s, pre-medicare) he was truly an intern and a resident. He literally lived at the hospital. They fed him, housed him and gave him a tiny "stipend" (he tells me it wasn't taxed at all as it was like a student stipend at the time) so he could buy clothes and take care of other incidentals. He and his wife dated all the way through medical school and residency because there was no way they could get married until he was out (she was a Nurse and brought home the bacon until he was done training).
The reality is that modern 20/early thirty somethings in training wouldn't accept this type of arrangement. So, it has become a job where they get paid more but also necessarily pay taxes for their own living arrangements, food, clothing, etc. With government mandated 80 hour work limits, it would be very difficult to tell trainees they were again compelled to live at the hospital to make it financially feasible for the hospital to train them without medicare dollars. Yes, there are probably other ways and this is but a little hyperbole, but knowing the bureaucracy that is most medical schools and CME departments, anything short of straightforward government funding sources is going to be a difficult sell (I suppose you could make residencies longer and require more research time and have residents support themselves on research grants ... but that too is a difficult sell as most want to get done before age 40).
Aren't M.D.s doing this to their own? Who else controls medical schools and residencies at hospitals, but M.D.s? No one, really. Me thinks there are medical doctors out there trying to make "specialties" exclusive – perhaps to keep up the large differences in INCOME between medical specialties. Why is there a difference in the first place? Are family practice doctors less valuable (to human life)? No. They only make less, because other DOCTORS over the past several decades have made these specialties artificially exclusive by only accepting the relative few. It isn't mear competence, because they all graduate med school, no?
Doctors have made this situation. Why do medical schools completely run by medical doctors charge so much? I bet they could charge much less.
Didn't match? Join the Post Doc Fellow brigade for exactly the same amount of pay you would have gotten as a resident! We newly minted PhDs (as well as the grad students you'll encounter in the lab) are nice and welcoming and will teach you all the lab skills you need. We could use your clinical knowledge! (Just don't bring your big ego.)
What would I need for such a post doc? I am really interested in knowing. Thanks
Why not allow these foreign doctors and those US MDs that don't get a residency slots work as PAs if they passed all other requirements to be a doctor? At least we can benefit from their medical skills (and the pay is much better than a waiter) until they get accepted to a residency program. Plus, the best "doctor" I ever had was a PA. For most medical treatment that doesn't require a specialist, they provide excellent care. I think most doctors are full of themselves thinking basic care can only be handled by those who have gone through the the needlessly brutal long hours of US residency programs, which is more of a macho rite of passage and a cultural artifact than a necessity–plenty of other first world countries do without it.
You do realize that PAs are supervised by doctors and that decisions concerning patient care have to be cleared by physicians before they be completed.
Also.....just to demonstrate how an n=1 sample size (i.e. the anecdote of 1 person's experience) is not sufficient evidence to support a conclusion. In the course of my dealing with my chronic disorder, a PA was one of the health professionals who gave me some of the worse care I have....but like I said that is as much the fault of the PA as it is as the physician supervising just like gains would be viewed in a similar light.
PAs are certified by a different body. A doctor can not be a PA because you can only be a PA if you graduate from a PA school. Foreign doctors are excluded from becoming PAs because they didn't graduate from an American PA school. Foreign doctors have to complete a few US school courses and then go to PA school for about 2 more years. That is, if they are accepted. PA schools have a reputation for not being foreign graduate friendly. The same is true if a foreign doctor wants to become a US nurse. So technically, a heart surgeon from Germany would need to study for another year to become a US nurse, or 2 more years to become a PA.
It is the responsibility of the medical school that graduated a student to train the candidate to enable them to practice medicine....like in India. In India, after 4 1/2 years of medical school training , graduates undergo a compulsory one year of residency in the same school after which they register with the medical council enabling them to practice life long . The American system is absurd...imagine training for nearly 8 years,a mountain of debt and not being able to practice...amazing!!!!
Medicine isn't alone with this problem. Behavioral medicine and the mental health profession is in the same boat. The matching system is being flooded with a ton of PhDs and PsyDs but not enough internships or post-docs to go around. Part of the problem is that it cost a large amount of money to even start an accredited internship/residency program. And right now there just isn't enough money to go around. 🙁
Well, the world needs ditch-diggers, too.
You can say that again.
Many people use backhoes now so many of the ditch diggers have lost their jobs.
It's worth noting that more expensive machines in most industries have reduced payrolls, while the opposite has occurred in medicine.
True.
Most problems can be solved by a PA. How often do you actually go to a doctor and they tell you something you didn't know already. I can actually think of one personally and it was a PA that told me.
Its true that PAs can handle a lot of medical problems but to imply that people can solely rely them for their health care is pretty misguided. PAs might be able to recognize common issue, and they can follow orders given by a doctor but they are missing a lot of training in the basic sciences that give doctors a better understanding of the underlying causes of medical issues. That way they can handle episodes that go wrong. Doctors lead a medical team. While PAs are valuable members they shouldn't be your only option.
Unfortunately, most of the general public would listen to anyone in a white coat.
I have my M.D. and have more than $400,000 of student debt I cannot pay back. I have applied for residency four times.
Wow, you took out that much in loans? Did you live it up in med school? What were your grades like in med school?
I feel so bad for you, this is the part many/most of these replies do not realize...and no you were not living it up when you have to pay over several thousand dollars beyond tuition to take the exams, health insurance (eh no free care for medical students) and maybe readers should log in and see the tuition at Med Schools for an revealing piece of info. The American students get the shaft, have to pay the loans, ECFMG may not have loan obligations while trying for residency. Where is the fairness? Any loan forgiveness due to faulty system, nope just pay up. Again, sorry.
We are a group on 350 IMGs US citizens/GC. Please join us on facebook Residency Ready Physicians. We need to be thousands for the government to hear us
All part and parcel of the quagmire of the public/private bureaucratic mindset in the US. If such problems manifested somehow in the human circulatory system, the result would be cardiac arrest. Maybe more government regulation will be the answer. The very thought makes my chest hurt.
If he is smart enough to be a medical doctor, I naturally wonder why he was stupid to come to this country.
Now we know where they get the "Dr" from to sell the snake oil cures on late night TV.
The Godfathers of the Medical Mafia (AMA) want to keep it this way, they will never let supply catch up to demand (they understand economics as well). Shortage of residency positions BS. When you have a shortage you don't make residents work a 24 hour shift and take a nap between emergencies. Personally I don't want some guy who has been on duty for 20 hrs and just awakened from his 30 minute nap making life and death decisions on me. Yet this is mandatory for residents as if they were going through some kind of Navy Seals training. So, why don't they do the sensible thing and hire 3 residents on 8 hour shifts, which would make a significant reduction in the backlog of residents. They don't want to increase the number of practicing doctors.
That also decreases the training hours for the resident by more than 50%. Conversely you could extend the training period by over 100% to compensate but no resident would agree to that,
This article is bland as hell.
A diploma, of any kind, has never been a guarantee of anything and it never will. It allows you to try and get a job or career in that field, that's it.
If anyone is thinking about attending medical school, think again . . . then think about ten more times. My son has been in the residency match for three years in a row and sadly, did not match again this year. It doesn't really matter if you take all the exams AND pass, the residency programs aren't satisfied with a "pass". They establish further criteria regarding how high your score actually was. It is a shame that students do not know how difficult it is to actually GET a residency position BEFORE they go to medical school and have hundreds of thousands of dollars in student loans which they have no hope of paying back.
Thank you. I"m glad I didn't go to medical school. I just survived, barely, in the work-a-day world with no ideas of grandeur. Fortunately, I have no big loans to pay off. I put that money into a home instead. Maybe I'm not such the looser after all. Maybe kids should think about doing real jobs instead of chasing money and status.
Hello, We are group of 350 IMGs US citizens/GC, inviting any medical graduates unmatched to join us Residency Ready Physicians on facebook. We need to be organization of thousands for the government to hear us
While I would have loved to be a doctor, I chose another medical path instead – specifically because of the problems listed here. Excruciatingly high costs to graduate, practice, and insure (malpractice) with locked or decreasing reimbursement is becoming bad for business. I have to wonder if there are fewer residencies in high risk fields such as surgery, because the liability risk for the attending physician and their facility just isn't worth it. It also strikes me as interesting that 5% of AMERICAN M.D.s were not matched, while many foreign M.D.s were. I feel for "Sam," but if his heart is set on surgery, perhaps he should return to his home country and apply to their residency program, and help his fellow countrymen.
Good points. I'm not sure the value of being American anymore. Does it mean anything? It seems that everyone in the world has the same privileges we do once they step foot on our soil.
I have a silly question, I'm an accountant, not a senator or health-care economist: Why not open up additional federal funding for residencies in high-demand, low-interest fields, in under-served inter-city and rural areas, for secondary match residents?
This is a little like the market for unsigned free agents who aren't drafted but have a shot at the D-league or practice squad.
OK, while you wanted to be a pediatric cardiologist, you aren't going to turn down a family practice residency with the Indian Health Service in Tuba City, AZ or at the Bureau of Prisons' MCFP Springfield, MO facility it the alternative is rattling off the dinner specials at an Olive Garden. It is a lot cheaper for the government to hire 90-100 hour per week medical slaves for $45,000 a year ($9 to $10 an hour with no overtime) than it is to hire more qualified AND pay off their student loans. Your initial quality yield may not be quite as high and you won't keep a lot of them after they're trained, but another crop will be standing in line for the chance to take their sports.
I'm glad my waiter was able to find a job. Sorry it wasn't in his field of choice. Sorry if he wasted his money on a speculative education. Darn, that is how most of us live. Furthermore, while he is my waiter, I expect him to treat me well and attend to my needs as a customer. When he finds a job as a physician and I hire him for a consultation, I will absolutely respect and heed his medical recommendations and advice. It's not 'who' we are that makes us better than anyone else. We are all the same, we can be waiters or doctors. It's only during the course of business that the education and skills become germane. So, I see nothing wrong with "Sam" being my waiter if that is what he chooses to do. I have always treated my customers with respect, I would expect the same from him.
Rob,
I've read your responses and your comments and quite frankly I find them all containing a single thread which is based on a profound misunderstanding of the premise of the article. That single thread is "Oh poor 'Sam', can't get his dream job, boo hoo! I'm a proud American who's happy just having a job and because he chose to educate himself and can't find work in his field he's a snob or he's trying to say he's better than a hard day's work" The profound misunderstanding is that he's actually working those two jobs listed in the article so he's willing to work to earn a living, he's not living on welfare or food stamps, he's working for a living. You said you "just survived, barely, in the work-a-day world with no ideas of grandeur. " What do you think Sam is doing? The difference is he decided that practicing medicine is what he wants to do so he's pursuing that goal rather than settling for the two jobs he already has.
To all the other posters who say "sometimes you don't get what you wanted" or "A diploma, of any kind, has never been a guarantee of anything", you're right in the sense that hundreds of thousands of undergrads graduate every year with degrees from anything in English Lit to Meteorology, and not every English Lit major will be Stephen King and not every Meteorology major will be on the Weather Channel. However there should be a reasonable expectation that you won't see English Lit majors talking about the trough in the jet stream while the Meteorology majors are teaching The Crucible to high school students. With Medicine it's more of an investment, because you do have to study hard and do very well as an undergrad, take the MCAT, be accepted to a medical school, study even harder, pass your USMLEs, and then be accepted into a residency program in the field you are interested in. If as some have suggested that people just give up, take the easy road and accept a job and settle rather than continuously strive for the career they invested in we'd have very few doctors, and then where would our country's healthcare be? Sometimes the measure of success is not what you have achieved but having failed to achieve and then overcoming that failure. To those of you that say things like "the world needs ditch-diggers", walk a mile in Sam's shoes and then see how it feels to go through medical school, have the diploma in your hands, wake up at 5:30 every morning and head to the hospital to be unable to use that medical knowledge for fear of practicing medicine without a license, then heading off to your other job just so you can pay off your medical school loans.
As someone who has been down a similar road as Sam and after a fair amount of time achieved a residency position in a field that I am passionate about, I applaud his tenacity. For those still in this position I truly hope you find your dreams, and finally to those that matched this year, congratulations.
I agree with you, big time!
What it comes down to is, a job is a job. If you dont want it dont take it. If you want, it try to get it , try to find it. If that doesn't work, go feel sorry for yourself. I dont want to hear a doctor complaining about being a waiter. It could be a lot worse. At least that MD doctor had the wonderful opportunity to learn about medicine at a University. Money only you takes you so far. Education and learning is infinite.
In Canada is even worse, we have MD's working as taxi drivers for a long time, if they are lucky, they will take a position at McDonald! Sadly...
With an M.D. I'm not eligible to work as an M.A.
Well, What a coloured and inconsiderate story to post about your friend *sam*.
Personally, I wonder what *sam* feels and thinks about his current issues and private situation.
Thank you for reminding me only to speak to private professional specialists.
Really who would be your friend if that is the content and opinion of his personal story.
Write about yourself rather then *sam*, fuel your ego with your own problems.
I believe you need more help then *sam*.
I do hope your book 'In Sitches' checks one box for your bucket list.
You are a very distasteful person due to your lack of empathy.
Well said! I agree! What a condenscending article! This jerk author probably ets off on the current misfortune of this so called friend of his. He should worry about his own fate instead of negatively predicting the future of others? What a lowlife!
Reblogged this on TheMedicalLife.
Why I cannot practice as a doctor even though I am fully certified. Residency-Ready.org
https://www.facebook.com/groups/ResidencyReadyPhysicians/
i would love to see your page on this dilemma but i don't use facebook. you need to make a normal website that anyone can access, not only a facebook user. lame.
Ever think there is a reason no match is made? Perhaps not as bright as the others? There is a tired, old joke that makes the rounds of each veterinary class: You know what you call the person graduating last in medical school? Doctor. Lots of DVMs, lawyers, etc waiting tables these days.
Not to worry-the present and unsustainable system is on the verge of financial collapse. In my opinion, the aqging of the baby boomers will force the move to some form of single payer. I will celebrate when the for-profit insurance industry dies as a result of its own hubris.
If you bozo's think lowering doctor salaries are the answer, then you might want to consider the idea of "quality control'. Right now, there is a level of competence a physician has, even before you know who they are. Go ahead, lower salaries, and get "B" grade students working on your aorta. I'll just go into financial analysis. I'm frustrated and beginning to think the extraneous BS i have to go through isn't even worth what I'm getting paid. Any lower, I'm out, and it's a shame because I love helping people.
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2 doctorates, 2 licenses, both from the University of California...still unemployed... I wish Obama would shut up about higher education being a guarantee of success! The more education you have, the more further training seems to be required for that job in your field!
for some reason, the story of the rich man and lazarus came to my mind after reading this story. Dr. Youn, if I were you I'd just worry about myself instead of others and their presumed hopelessness. I wouldn't be surprised if Sam and you switch places some day.
it's sad what the world has come to. getting an education has become a scheme for colleges to make money and gouge the eyes of those who pursue it. ridiculous exams and requirements which looks like nowadays leading to a dead end. sometimes I wonder what lawmakers are thinking when they enact new laws to make more requirements and restrictions in college. Then I realized its because they don't have a clue what students have to face. I say the policy makers should have civilian administered exams to determine if they are eligible for office for any type of policy making in the government or private sector. Why should these guys have all the fun making laws to make it harder for those out there trying to get an education, get jobs, and help this economy recover? if our lawmakers had similar requirements and exams to get into office, I think they would think twice before they make ridiculous laws esp in the education sector. its high time that we vote those kind of people out of power.
to the people out there who have found themselves educated but hopeless, all i have to say is the world will fail you because of its corruption and greed. God will never fail you though. God will make a way for you when the world tells you there's no way. All you have to do is trust in His Word. Be happy with whatever He gives you though. Don't ever compare yourself to worldly standards of success because it is plain dumb. Why? It doesn't matter because you hold on to nothing. We're here today and gone tomorrow from this world. No doubt, this world is passing away. Scientists, some who don't even believe in God, know that the earth will come to an end one day. The only thing you can hold onto forever is your relationship with God.
and its even more pathetic that just because a person was educated in a foreign country, they're now second class and being discriminated for that??? just wasting people's skills that can be put to use. at least create some good jobs where they can be used. and they wonder why the economy isn't recovering? why? just plain selfish and greedy.