A Comprehensive Solution to the Problem of Unmatched Medical Graduates

Today, Friday 3/18/2022, is Match Day.  This week tens of thousands of graduates of US MD and DO schools will find out what residency program they matched to.  And many tens of thousands will find themselves having not matched to any position at all.

These situations are always tragic- medical students have worked hard for 8 years (4 years undergrad, 4 years medical school), are often hundreds of thousands of dollars in debt, and find themselves with no clear path to making enough money to clear that terrible burden. Especially combined with projected future physician shortages AND the reality of current lack of access to care.  Many will declare that we need more residency spots to train more doctors. And we do. But the situation is more complex than it first appears, and reflexively increasing residency spots actually won't help anyone.

Instead, I propose these four steps, which will address the root causes of the problem, and create enduring change.

1. Funding for more residency spots, accompanied by a national healthcare workforce commission empowered by congress to conduct and analyze research into future workforce needs, and allocate (and re-allocate) GME funding for MD and DO residencies accordingly
2. A multi-step match. 1st step: US MD and DO grads. 2nd step (1 month later), unmatched US MD and DO grads along with Foreign Medical Graduates (FMGs) and US citizen graduates of international medical schools (IMGs).  This should be accompanied by a repeal of the NRMP provision requiring programs to offer all of their positions in the match.  Meaning if they want to specially recruit an FMG due to research or other relationships, they can still do so.
3. For all US MD and DO graduates, IMGs, and FMGs who pass Steps 1, 2, and 3: guaranteed entry into special Physician-Assistant Qualification pathways, which would be 6 months long and allow them to gain licenses as PAs.
4. Forgiveness of all educational debt for any US MD or DO graduate AND any US IMG who does not match 2 years in a row, and who does not qualify for a pathway to practice as a PA
5. If we retain preliminary residencies, then for all graduates who successfully complete a 1 year preliminary or transitional year residency (which do not lead to board certification and consequent allowance of independent practice), we fund and establish guaranteed reserve family medicine 2 year residencies.  These "completion" residencies would ONLY be open to such graduates, and would have to go unfilled otherwise.

Residency Work-Hour Restrictions Ought to be Individualized

There's been a bit of kerfuffle over resident duty hours lately.

For those unfamiliar with the topic, physicians in training in the United States have traditionally lived in the hospital- hence why they were called residents- and available to patients 24/7.  Over time, concerns about patient safety led to limits on how many hours could be worked consecutively in the hospital.  In 2003, the maximum number of hours worked per week was restricted to 80 hours.  In 2011, the maximum work day for first year residents was restricted to 16 hours- for second year residents and above the limit was set at 24 hours of work plus 6 hours for handing off patient care.

The Residency Application Process suffers from Misaligned Incentives

Doctors who wish to practice in the United States must apply for and undergo a residency in a particular specialty in order to practice medicine.  Some residencies are considered more desirable and competitive than others.  I am a fourth year medical student, applying for a General Surgery residency, and I have to say the process of applying to residencies has gotten somewhat out of hand.