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.

I support affirmative action. I support holistic review. I do not support holistic review used to achieve affirmative action.

The world of medicine has been roiled recently by an article published in the Journal of the American Heart Association.  The author, Dr. Norman Wang, MD (since fired from his job as an cardiac electrophysiology fellowship program director) argued against affirmative action in medicine, believing that individuals with "weaker" academic credentials shouldn't be accepted into medicine programs.  It was subsequently condemned as racist and retracted.

President Trump is Ignoring America’s Trump Card in the Conflict with China

President Trump recently announced a series of harsh measures against China, including the suspension of entry of all graduate and post-graduate students into the United States.  I can understand the desire to protect American intellectual property by preventing students from learning skills and intellectual property and then returning to China and making use of them without royalties.  But a blanket ban on the entry of Chinese students ignores how the fields of medicine, science, and engineering really work and is likely to backfire spectacularly.

The Rule of Law is Dead in Medicine

The United States is a nation of laws, not of men's dictates.  The rule of law is what keeps (most) drivers from routinely running red lights, police officers from demanding bribes, and our civil servants and elected officials largely honest.  There of course will be violators of this code, as there are in any society, but nonetheless compared to many other nations in the US most citizens and state officials believe the laws are legitimate, and by and large obey them.  One of the most bitter criticisms of President Trump and proximate cause for his impeachment proceedings is that he is breaking down a critical part of the rule of law.  By using tools of state commonly felt to be apolitical (foreign policy, the justice department) to go after his political opponents; issuing executive orders that seem to punish certain religious or ethnic groups, thereby legitimizing white supremacy; and attacking institutions respected by all such as the FBI, intelligence agencies, and the judicial branch- he is accused of slowly diminishing respect for those institutions and the sense that the institutions of the state serve all citizens fairly and equally.  This then threatens to breakdown the trust that all Americans have in our nation, which is critical to its continued existence.

Governor Northam's Comments about Abortion, Explained, and a Proposal for Compromise

Democrats in Virgina made a massive own goal this week- and that was before Governor Northam, a renowned pediatric neurologist, was possibly found to have done blackface OR dressed up in a KKK outfit 30 years ago at a Halloween party.

Disclosing Conflicts of Interest on Twitter is Security Theater at its Finest

Conflicts of interest (COIs) have been in the news lately, with the resignations and public mea culpas of several prominent figures over undisclosed conflicts of interest in journal articles.  Memorial Sloan Kettering is one of the two top cancer hospitals in the United States: unequaled by anyone other than MD Anderson in it's advanced, cutting edge care. The Chief Medical Officer of that institution spectacularly resigned after failing to note millions of dollars in payments by pharmaceutical companies he had worked with in journal articles which he wrote.

Now I will disclose here that I am a Baylor College of Medicine General Surgery resident who will rotate at MD Anderson.

As their roles change, Pharmacists need new Regulations, Norms, and Freedom from Corporate Interests

Pharmacists play an essential role in the healthcare system today, one that is ever-expanding.  They check for drug interactions, watch for signs of opioid over-prescribing, and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has.  In hospital units, their roles have become yet more complex- often serving on various quality committees, managing daily dosages of medications like warfarin and vancomycin, and more.  I rely upon them in the hospital daily- to catch mistakes, and to advise on drug dosages and choices.  Many in the community give flu vaccinations, and some are even trying to gain "provider" status under Medicare, allowing them bill directly for treating patients.  This has been accompanied by a drastic change in the preparation of the average pharmacist- where once it was a 5 year bachelor's degree, now it is a graduate degree- a change recent enough that as of 2014, over 60% of pharmacists practicing had trained under the old system.