One Doctor’s Quest for Residency
Many Americans assume that anyone who graduates from medical school is all but guaranteed a financially secure future. Even after assuming large loans to cover the cost of education, the payoff is expected to include at the very least an upper middle class income, a home in a nice neighborhood, a respected position in society and enough income to repay the debt.
Yet since 2011, Dr. Doug Medina has been forced to string together minimum wage jobs and unpaid research positions that barely put food on his table or a roof over his head. The graduate of Georgetown University School of Medicine may have earned a doctorate in allopathic medicine, but he has yet to be selected for a residency. Without that training, he cannot be licensed to grab his piece of the American Dream – a lucrative career in medicine that will allow him to pay down a $300,000 student loan.
“I haven’t been able to pay anything yet, and interest rates are killing me,” says Medina. “It’s very stressful. You begin to give up hope that you’ll ever be able to own a home or a new car in this lifetime,” he says, adding, jobs in a butcher shop and unloading trucks at a big box store won’t retire his debt.
If Medina’s elusive quest seems more Greek mythology than hard-luck tale, that’s because his odyssey has entangled him in one of this nation’s hot-button issues – immigration.
In the seven years since Medina graduated from medical school, data from the National Resident Matching Program reveal that, from 2011 to 2018, 14,759 U.S. seniors and previous graduates did not matriculate into residency training. In that period, there were 27,866 foreign trained physicians [FTPs, non-U.S. international medical graduates (IMGs)] on H-1B and J-1 visas selected for residency.
A J-1 visa is a nonimmigrant document issued by the U.S. government to research scholars, professors and others participating in programs that promote cultural exchange, especially to obtain medical or business training within the U.S. An H-1B visa is used to employ international workers in specialty fields.
Federal dollars from Medicare annually underwrite residency training positions for about 3,700 non-U.S. IMGs. This leaves about 1,800 American-trained medical students without a job each year. Reducing the number of IMGs who receive residencies, and prioritizing American grads, would help correct the problem.
“I don’t want to completely exonerate the student. We must go after these jobs and interview well,” says the Colorado native who has applied to hundreds of alternative careers since returning in 2013 from Floating Doctors, a nonprofit medical group that provides healthcare to developing nations worldwide. This has included positions ranging from Psychiatry Aide, Research Assistant and Lab Technician to Health Inspector, Ecologist and Epidemiologist.
“When I followed up with various positions that I had applied for, I was told I was overqualified or lacked specific qualifications,” says Medina. With the large debt load in student loans from medical school, he says he simply would not qualify to take out more student loans for additional training to seek specific qualifications for these alternative careers.
“To date,” Medina continues, “the only career I’ve found that requires a doctorate of allopathic medicine without resident training is an international Health Scientist for the Centers for Disease and Prevention, and I applied to every position from Albania to Yemen.”
Making the Grade
Nationwide, about 94 percent of medical school graduates are placed in residencies each year, with a 6 percent deficit. So, what happens to those U.S. graduates (more than 1,000) who don’t make the cut? Medina passed all of his courses, never failed any clinical or course work during medical school and in his final year earned honors in five courses. “I am not the problem. The problem is a serious flaw in policy that is not protecting vulnerable medical students trained in the U.S.,” he says. He believes that schools should help graduates matriculate into residency training or find an alternative career.
For this reason, Medina chafes when it is suggested that a non-U.S. IMG is more qualified (higher test scores) and therefore deserves a residency denied an American-trained doctor. He was surprised and angered to learn that FTPs who had failed multiple courses were chosen over him in some instances.
Misinformation is also a barrier. The immigration debate assumes FTPs are filling positions in rural outposts unattractive to U.S.-trained doctors. Yet data show that doctors with J-1 visas are regularly placed in New York, Michigan, Texas, Ohio, Florida and Pennsylvania. Further, according to a story in Time, one internal medicine program reported that 60 percent of its incoming residents are on, or are supposed to be on, H-1B visas.
“These data indicate that the rural argument does not justify hundreds of U.S. medical students – who invested a quarter-million dollars, or more, for an education – losing jobs to FTPs who don’t have huge school debts to pay,” says Medina.
His disappointment also reveals why he is haunted by a joke told by educators during his orientation to medical school: What do you call a medical student who finishes last in his class? The punch line – A doctor – suggests that anyone capable of surviving the rigors of an American medical school education is worthy and qualified to aid the sick and pursue a career in Medicine. Medina is not laughing any more.
Medina has filed formal grievances with the Association of American Medical Colleges and the Liaison Committee on Medical Education. But, so far, his lone voice has not been recognized.
It is incorrect to assume that a person with a doctorate in allopathic medicine can find a good job in another field. Medina and other graduates have earned a very specific diploma that does not lend itself to other careers. Medina has a list of hundreds of alternative careers to which he has applied for jobs, and, as noted, he’s often rejected as “overqualified.”
Yet even if a job were available, simple math flatlines economic survival. For example, if Medina could raise the money to invest in a nine-month program that delivers a teaching certificate, perhaps he could find a job teaching high school biology. At the high end, he would earn an annual salary of $60,000. But even if that income were garnished 25 percent, or $15,000 annually, it would take the next 25 years to pay back a $375,000 loan. (Most doctors pay off their loans in 8 to 12 years. The average salary for a physician is $10,000+ per month.)
Since 2011, Medina’s $300,000 in student loans has expanded to $400,000 due to a 6.7 percent interest rate, which adds about $60 daily. Meanwhile, FTPs may see teaching as an excellent alternative because they carry no crushing debt. Their birth nations have different methods of providing a medical education.
Broken Heart and Rats
Medina was engaged to be married for six years to a fellow doctor whose professional life flourished after graduation, while he continued to apply for residencies. Ultimately, she ended their relationship, saying, “I can’t keep waiting for you to move forward.”
He also has had to rely on his parents for financial assistance. His father, an émigré from El Salvador who served in the Vietnam War, allowed his son to move into the basement of the family home but not without criticism. “An adult son should not have to rely on his parents,” he told Medina. Although his mother has been more understanding, her financial assistance has stalled her retirement plans.
One of Medina’s lowest points came while he was in Buffalo, New York, picking through rat feces under the “Honeymoon Cage” and analyzing it to breed rats with a specific genetic predisposition. Though the job did not include pay, he earned a valuable publishing credential as co-author of “The Habituation of Reinforcer Effectiveness” by Dr. Jerry Richards.
“This is when I began to feel depressed. I thought, is this what I finished my doctorate for?”
Yet research is important, and very few new doctors have published. That break may enhance Medina’s resume, along with numerous volunteer positions, including stints with San Lucas Hospital, the Mental Health Clinic at the VA Medical Center in Washington, D.C. and Floating Doctors.
For Medina, hope springs eternal. In the spring, the annual process of matching doctors to residencies begins again. Also, he recently was hired part-time by Spring Mountain Treatment Center in Las Vegas, earning $30 an hour doing patient intake. He’s encouraged, for if he does well, his weekly hours will expand, and he’ll earn a letter of recommendation to include in his quest to be licensed.
“I’ve lost years of my life, but I haven’t given up,” Medina says. “And if I continue to address the immigration policy issues, maybe this will help other students as well.”
13 August 2018