Unmatched Citizen Doctors Question Fairness of Matching Process

In only one profession can students who graduate from an advanced learning program, pass all the required exams and yet, because of bureaucratic red tape, be barred from employment. The profession is medical doctors. After doctors graduate from medical schools, they must go through the matching process before they can obtain a residency at a teaching hospital. Without completing a residency, doctors cannot practice.

Decades ago, holding an MD degree practically guaranteed that a doctor would have the opportunity to practice. In 2020, however, about 6,500 U.S. doctors in good standing went unmatched; similar shortfalls of U.S. taxpayer-funded residencies have occurred in earlier years. Thousands of previously unmatched doctors hope that on March 19 when the National Resident Matching Program (NRMP) announces its selections, they will be among the fortunate chosen. The NRMP touts its 94 percent match rate, but that statistic also means the remaining 6 percent of doctors are stuck in professional limbo.

Every year, thousands of medical school graduates conclude their academic careers with virtually useless MD degrees. In the process, they have incurred huge debt, often reaching into moderate six-figure totals. The median medical school debt for 2019 graduates was $200,000, according to the Association of American Medical Colleges. Residency application fees add to their debt burden. Students who match into residency positions soon advance to become attending physicians, and make an average $200,000 annual salary that allows them to pay down their indebtedness. But unmatched doctors are left to their own devices, and in the current pandemic-distressed economy are often forced to settle for hourly wage employment. For citizen MDs to be banished to the sidelines during the coronavirus medical emergency, while patients go wanting and the doctors who serve them are overburdened and exhausted, is inexplicable.

For years, the Association of American Medical Colleges has predicted that the U.S. will face a dire physician shortage. Last year, the AAMC report on the projected doctor shortfall predicted that by 2033 the nation would need between 54,100 and 139,000 physicians in both primary and specialty care. The pandemic may further exacerbate the shortage. However, there are thousands of qualified, but unmatched U.S. doctors who are bureaucratically barred from practicing.

In a New York Times story titled, “‘I Am Worth It’ Why Thousands of American Doctors Can’t Get Jobs,” Dr. Faarina Khan said, “Hospitals need to realize that there are people in my position who could show up to work in the next hour if we’re called.” Dr. Khan passed her licensing exam on her second try but was shut out of the matching process. Over the past five years, Dr. Khan has spent more than $30,000 in residency application fees. But with an assistant physician license, she was able to join the Missouri Disaster Medical Assistance Team last spring which enabled her to assist in medical facilities where staff members had positive coronavirus test results. Working as an assistant physician is not the goal Dr. Khan had envisioned when she enrolled in medical school.

Dr. Doug Medina, a 2011 Georgetown University School of Medicine graduate with a doctorate in allopathic medicine, is another example of a qualified but unmatched doctor. Dr. Medina passed his clinical training and all his medical school coursework, earned honors in five Acting Internship clinical rotations in his final year of medical school, passed the United States Medical Licensing Exam (USMLE) Steps 1, 2 and 3, and has published at the Research Institute on Addictions. But the matching hurdle prevented Dr. Medina from getting a job in his chosen profession.

In the Times story, Dr. Adaira Landry, a Boston-based emergency physician, said about the unmatched young doctors she mentored: “They want to be part of our health care system. But they have this boulder blocking them,” a reference to the matching process. U.S. citizens who graduate from international medical schools have a steeper uphill climb. Only 49.9 percent match, while non-U.S. citizens matched at a 51 percent rate.

There are solutions that could be implemented with relative ease that would go a long way in putting American doctors to work. First and foremost, American doctors should be prioritized in the Supplemental Offer Acceptance Program (SOAP). The SOAP affords doctors who did not match in the Main Residency Match to apply for residency positions that went unfilled during the initial Match. Another short-term solution would be to provide medical malpractice coverage for doctors who did not match and are looking for ways to enhance their clinical experience while waiting for the following year’s Match.

Long-term solutions could include a 25 percent reduction in the number of nonimmigrant visa holders entering the country through programs such as the J-1 (a cultural exchange program) and H-1B (a nonimmigrant work visa program) and filling resident physician positions. This alone would ensure that every senior medical student who graduated from a U.S. college would be placed in a residency program.

The website Doctors without Jobs is dedicated to raising awareness about the current system’s inherent injustice and to exploring ways to increase the number of residency positions, as well as reviewing how the Accreditation Council for Graduate Medical Education and the NRMP could prioritize U.S. medical students for residencies, and how the AAMC could provide basic assistance to citizen doctors who don’t obtain residency training. For more information, contact Doctors without Jobs founder Kevin Lynn at klynn@pfirdc.org.