A Ten-Year Residency Quest, Test of Endurance

Dr. Doug Medina
Dr. Doug Medina

Most Americans assume that a U.S. medical school graduate will have a rewarding future practicing as a doctor.

But for Dr. Doug Medina, a 2011 Georgetown University School of Medicine, Washington, D.C., graduate with a doctorate in allopathic medicine, the outcome was starkly different.



Dr. Medina hasn’t been chosen for a medical residency. Without residency training, he can’t work as a doctor licensed to practice. In their personal lives, non-practicing doctors such as Dr. Medina struggle to pay back the student loans for a medical education that carries a steep price tag.

According to data from the National Resident Matching Program (NRMP), about 94 percent of U.S. medical school graduates do place in residencies each year. That number may sound good, but it means the remaining 6 percent of doctors are in professional limbo after committing years of their lives to a very specialized education.

“The problem is a serious flaw in policy that is not protecting U.S. citizen medical students,” says Dr. Medina, who never failed any clinical training or any course work during medical school, earned honors in five Acting Internship clinical rotations in his final year of medical school, passed the United States Medical Licensing Exam (USMLE) Step 1, 2 and 3, and has published at the Research Institute on Addictions.

According to NRMP statistics, in the last ten years, thousands of U.S. citizens graduating from U.S. medical schools – up to 2,000 each year – and more from medical schools outside of the U.S. didn’t place into medical residencies.

For the same ten-year period though, more than 36,000 foreign trained physicians (FTPs, non-U.S. international medical graduates) on H-1B and J-1 visas have been given U.S. residencies. Looking just at 2020, federal Medicare dollars funded residency training positions for about 4,200 non-U.S. IMGs.

There’s increasing anecdotal evidence that the profession is showing the same trend lines as with technology workers being displaced by H-1Bs over the last 20 years. The 4,200 IMGs given taxpayer-funded residencies in 2020 are up from 2,700 in 2011, edging up each year since then, per NRMP data. There are a number of residency training programs that select a high number of non-U.S. citizen IMGs over U.S. medical students. According to a story in Time, one internal medicine program reported that 60 percent of its incoming residents are on, or are to be on, H-1B visas.

With a 6.7 percent interest rate, Dr. Medina’s original $300,000 in student loans have expanded to more than $400,000. Dr. Medina has filed formal grievances with the Association of American Medical Colleges and the Liaison Committee on Medical Education. But to date, Dr. Medina’s complaint hasn’t been acknowledged.

After a part-time, graveyard shift working as a patient intake specialist in Las Vegas, where he earned $30/hr., Dr. Medina was laid off during the pandemic. He landed in Southern California working as a clinical documentation specialist at a lower pay rate. He continues to persist in his pursuit to obtain a medical residency.

“I haven’t given up,” Dr. Medina says. “If I continue to address the immigration policy issues, maybe this will help other students as well.”

Dr. Medina offers several solutions, including:

  • The State Department should reduce to 2,000 annually the total IMGs who receive residencies. This would keep the pipeline for foreign doctors open, but create more opportunities for U.S. graduates.
  • Medical schools should provide greater assistance to graduates so they can find residency training or alternative careers.
  • Make ERAS application fees affordable. It shouldn’t cost more than $8,000 to apply for a job in the U.S.
  • Prioritize Preliminary Years at Affiliate Training Hospitals for U.S. medical students.
  • Prioritize Preliminary Years in the Supplemental Offer Acceptance Program (SOAP) for U.S. medical students. Every U.S. medical student should have a one-year Preliminary Year position before the Association of American Medical Colleges allows non-U.S. citizen IMGs to be hired for these positions.


Updated 20 October 2020