For too long, too many American medical school graduates have been sidelined in their careers. Students first enter a highly competitive process to be accepted into medical school. Then they commit years to studying to become doctors. Most students also take out significant student loan debt – $250,000 on average – for their education. After all that, thousands of U.S. doctors are stopped in their career track when they can’t obtain taxpayer-funded medical residencies. Without a residency at a teaching hospital, a doctor cannot be licensed and thus cannot practice medicine.
This has been the widely unreported and unaddressed issue for many years now, with graduate medical education (residency training) unchanged in positions available since 1997, despite a growing population that requires more doctors to meet their needs. This incomprehensible situation that has been allowed to develop means that we now have a current estimated shortage of between 20,000 and 60,000 physicians in the United States, according to Unmatched and Unemployed Doctors of America. That number, the group reports, is expected to increase to 140,000 in less than a decade. Yet, in 2021 alone, 7,400 medical school graduates who are U.S. citizens and lawful permanent residents did not match to a residency.
So, the need for more residencies is very real. Additionally, as we leave our own doctors benched, in the last decade the U.S. has given more than 40,000 taxpayer-funded residencies to doctors from other countries.
There are solutions
The Resident Physician Shortage Reduction Act of 2021, S.834, and H.R.2256 in the House, is a start to addressing the crisis of unmatched physicians. This proposed legislation would amend title XVIII of the Social Security Act to provide for additional residency positions, including for rural and underserved areas.
The legislation does not currently include, however, prioritization of U.S. citizen medical school graduates and lawful permanent residents for the new residencies. This needs to be amended to prioritize Americans for the additional taxpayer-funded residencies that would be created.
Equally important to creating new residency slots is ensuring that existing residency training positions go to medical school graduates who are U.S. citizens and lawful permanent residents. Program directors who oversee residencies must be held accountable to American taxpayers who are footing the bill for this advanced training. American residency spots need to go to American doctors. Once all of our doctors are in residency, then we can look at labor from outside the country. But even before that, we should be asking why we can’t train and hire all the doctors the country needs for the U.S. from the U.S.
Not only do program directors need to be held accountable to American taxpayers, but medical schools also need to be held accountable to them and the doctors they are graduating. If we continue graduating doctors and not allowing them to work, there are multiple costs borne by all of us. The doctors suffer as they are not able to contribute to their communities in the very specific field for which they trained and are unable to provide for themselves and their families, and service their debt load. Ultimately, when they can’t repay their student loan debt, the taxpayers are on the hook.
One more solution is for medical schools and the Association of American Medical Colleges (AAMC) to help those who do not match into residency move into alternative careers, such as assistant physician.
Protecting those who have earned the right to practice medicine by ensuring they can practice is essential to the common goal Americans want: a quality healthcare system for all. It is time for the AAMC, the National Residency Matching Program (NRMP), the Accreditation Council for Graduate Medical Education (ACGME), the Council on Graduate Medical Education (COGME), medical schools and our elected officials to address this crisis and craft the solutions to put all qualified U.S. doctors to work.