For basketball fans and players, the third month of the year means “March Madness,” one of the biggest sporting events. March for some college undergraduates means spring break in exotic locales. For thousands of this year’s medical school graduates, March means the exciting culmination of eight years of higher education — undergraduate training and medical school — and the next step in the medical profession: residency training. But for thousands of other doctors, it means rejection, doubt and questioning the way forward.
Residency training is the additional hands-on learning that occurs at a teaching hospital or clinic after a doctor has graduated from medical school. Residencies are funded by taxpayers at a cost of about $150,000 per year. Of that, the average medical resident earns $64,000 a year. The length of training can last from two to five or more years, depending on the specialty area. Residencies are grueling and punishing, with exceedingly long hours. To apply for a residency, doctors must have passed USMLE (United States Medical Licensing Examination) Steps 1 and 2, also known as the board exams.
The National Resident Matching Program (NRMP) is the nonprofit organization that has been “matching” doctors to residency programs since 1952. Public perception for a long time has been that once a doctor graduates from medical school, that’s it. A doctor is a doctor and can go forth and practice medicine. And that was pretty much true for several decades. But then began a divergence. There were more doctors — including ones from other countries — applying for residencies than there were residencies. A major factor was the 1997 Balanced Budget Act (BBA), which capped the number of residents and fellows that the federal Medicare program would support. And Medicare was the single largest source of funding for graduate medical education (GME). Not until the end of 2020 was there an increase in residency positions when H.R.133 — Consolidated Appropriations Act, 2021, was signed into law. The legislation included funding for 1,000 (200 slots per year over five years) new Medicare-supported GME positions.
In this year’s Match, NRMP put the positive spin on the numbers, reporting, “The 2022 Match realized many significant milestones including a record number of U.S. MD and U.S. DO [doctor of osteopathic medicine] senior applicants and the largest number of total and first-year positions offered.” But the reality is that more than 7,000 doctors who are U.S. citizens and legal permanent residents still don’t have residencies. Thus, we continue to fail our doctors who have invested years and hundreds of thousands of dollars for their training and who are eager to contribute to America’s healthcare system and alleviate the much-discussed looming U.S. shortage of between 38,000 and 124,000 physicians in both primary and specialty care by 2034.
Last month, Kevin Lynn, cofounder of Doctors without Jobs, testified before the House Committee on the Judiciary on the topic, “Is There a Doctor in the House? The Role of Immigrant Physicians in the U.S. Healthcare System.” Lynn emphasized that not only are we sidelining our talent, but we’re also subsidizing doctors from other countries by importing them to fill U.S. taxpayer-funded residencies. The number is significant: more than 40,000 foreign doctors have been given taxpayer-funded residencies in the last 10 years.
This issue impacts every American who accesses the healthcare system. Unmatched doctors and American citizens alike should call and write their elected officials — weekly, until this is fixed — and ask that they prioritize our doctors for residency positions. Current legislation, H.R. 2256, The Resident Physician Shortage Reduction Act of 2021, would create more residency slots, but in its current iteration, it does not prioritize U.S. physicians for these spots. H.R. 2256 needs to be modified to hire American doctors first.
U.S. politicians have had no problem in recent weeks quickly finding $14 billion, which includes weapons, not just humanitarian aid, for the Ukraine. But for more than a dozen years, these elected officials haven’t been able to find the dollars to take care of American doctors. Maybe there’s no money to be made for American elites and the political class by fixing this problem.
by Maria K. Fotopoulos
Maria Fotopoulos works with Doctors without Jobs on communications issues.