Stuck in the Middle

Dr. Faarina Khan
Dr. Faarina Khan
Dr. Faarina Khan

An American doctor who fell through the cultural cracks on the way to residency becomes a strong advocate for change. Assistant physician Faarina Khan is not letting challenging circumstances stop her from paving the way for other doctors in the same boat.


Update: Congratulations to Dr. Khan who matched to a residency in March 2021 in Oregon.

Growing up in a Pakistani-American family in Chicago, Dr. Khan graduated high school and chose to attend Dow International Medical College (DIMC) in Karachi. This decision was influenced by comparatively lower costs than American medical schools, eliminating the burden of student loans. It was also an opportunity to connect with extended family and immerse herself in the culture.

The five-year program is patterned after the India/United Kingdom model and is comparable to a four-year M.D. degree in the United States. But unlike U.S. medical schools, DIMC does not build the U.S. Medical Licensing Exam (USMLE) into the curriculum. During her year-long post-grad clinical internship at the medical school’s hospital, in order to be ready to apply for medical residency immediately upon completion of the internship, Khan also studied for and took the USMLE Step 1 and both parts of USMLE Step 2.

But she has not matched to a residency since graduating from medical school in 2015. Now five years out of medical school, she is an “old” graduate in the eyes of residency program directors who favor those within two years of medical school graduation. Cultural factors are at play as well. “Because international medical graduates are stereotyped as visa-requiring foreigners with limited English proficiency and subsequent articulation issues, they overall are assumed to be ignorant of American norms and the usual way of doing things,” Khan explains. “But I was born and raised in the U.S. I’m in the middle – an American, but an IMG.”

Khan chose to channel her frustrations at not landing a residency into keeping her clinical skills current and advocating for unmatched doctors. Since 2018, she has been licensed as an assistant physician in the state of Missouri, and has served as the Chief Assistant Physician for the Medina Clinic in Grandview since March 2020, a role that entails coordinating her assistant physician colleagues in addition to continuing to provide clinical care to the uninsured patients who make up the clinic’s core demographic. She also volunteers for the Missouri Disaster Medical Assistance Team as an assistant physician to aid with COVID-19 testing/screening and staffing facilities whose workforce was negatively impacted by the pandemic.

Missouri is one of the few states that licenses assistant physicians, who work under the supervision of a practicing primary care M.D. in medically underserved areas. “The state has 360 actively licensed assistant physicians and about 100 of them are actively volunteering or being paid,” explains Khan. Utah’s licensing program uses the Missouri model, but has stricter criteria; Utah licensees only have six months to find a collaborating physician to work under before their licenses expires. Arkansas and Kansas have used a similar concept, but cater only to graduates from medical colleges in their respective states.

In addition, Khan is serving as interim president of the newly formed nonprofit National Association of Assistant/Associate Physicians (NAAP). The organization’s goal is to bring the group up to the recognition and funding levels of similar groups advocating for other medical professionals, like nurse practitioners and physician assistants.

One important area of focus is improving workforce development and instituting a range of base pay for assistant physicians, some of whom are making minimum wage or nothing at all. A major reason behind this is that Medicare does not yet recognize assistant physicians as billable providers. If an assistant physician is a billable provider, s/he can get paid for services just as physicians and mid-level providers can. NAAP has been working with a Missouri state representative to request that the Centers for Medicare and Medicaid Services (CMS) recognize and subsequently include assistant physicians as billable providers.

Khan is also one of several cofounders of the nonprofit American Society of Physicians (ASP), which is working to empower the unmatched physicians in the U.S. According to data from the National Resident Matching Program, in the last ten years, thousands of U.S. citizens who graduated from medical schools outside of the U.S. did not match to a residency.

This is in addition to as many as 2,000 medical school graduates of U.S. medical schools who didn’t get a residency in the same time period. During the same period, more than 36,000 foreign trained physicians [FTPs, non-U.S. international medical graduates (IMGs)] on H-1B and J-1 visas were selected for U.S. residencies. Looking just at 2020, federal dollars from Medicare underwrote residency training positions for about 4,200 non-U.S. IMGs.

“Unmatched M.D.s are stuck flipping burgers or driving for Uber just to survive,” Khan said. “This is not why we went to medical school. We want to be able to save lives with our knowledge and training, but we are hampered by a senseless centralized residency matching system with too many middlemen. The U.S. healthcare system has sadly deteriorated into nothing more than another business.”

Given these sobering statistics, a major goal of ASP is to encourage state legislators to support key pieces of legislation (such as the Resident Physician Shortage Reduction Act) that will ultimately increase the number of residency training positions. Khan is advocating for assistant physician laws in other states to allow eligible U.S.-based medical graduates to serve in patient care roles under direct supervision.

“Contrary to popular belief, we don’t have a physician shortage – what we actually have is a training shortage,” Khan explains.

“We are trying to fix a very broken system with education and awareness, and simply bridge the gap between medical school and residency while helping to alleviate the healthcare shortage in areas of greatest need,” she added.

Khan would like to think that her home country would be willing to be supportive in her efforts to help Americans with their healthcare needs. “There are so many MDs who give up, but that is not in me. Even if I can’t implement significant change soon enough to benefit myself or my current colleagues, being able to clean things up long-term and smooth the journey for future U.S. doctors is still worth putting in the effort now.”

1 December 2020