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.

The LA Times's crucifixion of Dr. Puliafito is not appropriate, and has left the most important question unanswered

Two weeks ago the LA Times broke a story that Dr. Carmen Puliafito, former Dean of the Keck School of Medicine of USC, had been abusing drugs and keeping company with a group of younger individuals who engaged in drug use and illicit activity.  Much of this activity occurred while he was Dean, and it is a shocking story- a 66 year-old titan of the field of ophthalmology, renowned for inventing a device that revolutionized the field and forging both the 1st and 2nd ranked programs in the country (University of Miami's Bascom-Palmer and previously USC's Doheny before its split)- found partying with a prostitute and her friends while taking methamphetamine and other drugs.

As an Intern, I Support the ACGME's Increased Duty Hour Limits

Last month, the ACGME formally increased its work-hour limits for resident physicians, a change that was widely covered in the press.

This decision has also been significantly mis-reported.  While it may seem like all residents will now work for longer hours, in reality, only first year interns will be allowed to work longer 24 hour shifts, where the previous maximum was 16- a limit adopted in 2011.  2nd year and up, the restrictions will not change: 24 hour shifts, no more often than every 3rd day, with an 80 hour per week average which were the restrictions adopted in 2003.

Questions to ask When Picking a Medical School if You Want to be a Good Doctor

I graduated medical school this May from the Keck School of Medicine of USC.  And only now can I speak about what I should have cared about when picking a medical school in the first place.  Originally, I had picked USC for a unique medical engineering program called Health, Technology, and Engineering, and because I heard colloquially that it had good clinical training since it had a major county hospital.  I was extremely fortunate that I did so.

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.

To my Fellow Medical Students: Beware before Judging your Residents, for you may Easily Become them

A recent paper in the Annals of Internal Medicine has sparked a large news media response.

In it, two incidents are described: in one, a male obstetrician-gynecologist is prepping a patient's vaginal area for surgery, which involves running a brush soaked in betadine or chloraprep solution over the labia, mons pubis, perineum, and inner thighs when the patient is already put to sleep by anesthesia.  He makes an appalling joke, "I bet she is enjoying this".

In the second, another male obstetrician-gynecology resident runs into a room with a patient bleeding to death from her vagina.  He controls the bleeding with manual pressure, putting his hand into the woman's vagina.  And then, when the crisis is over, he starts dancing and singing, while his hand is still in the woman's vagina, keeping the woman from bleeding again.

Many comments, especially from other medicals students, are condemning the behavior of these doctors and likening it to sexual assault.

I make no excuses for this behavior.  But while it is easy for us as medical students to judge, the reality is that residency will put us all at risk of becoming these doctors.  The lesson here should not be "what monsters!", but rather "I must make sure I never become them".

Medical Student Mental Health: the Root Cause is the Grading System

For two years, I served as a representative to my medical school's Student Affairs committee.  My job was to convey medical student concerns and problems.  As part of that role, I had a lot of time to think about how and why many medical students experience depression and stress, which is an incredibly large problem.  At one school, prior to intervention, 27% of students had depression and over 55% had anxiety. Two recent articles have led me to write about the issue now.

Ivy League Schools face an Anti-Asian Discrimination Lawsuit, are Medical Schools next? (Spoiler: Probably Not)

In the news recently has been a complaint filed by over 60 Asian-American groups, alleging discrimination in admissions at Harvard.  They point to such statistics as this: in 2009, among accepted applicants to the Ivy League, the average SAT score on a 1600 point scale for Caucasians was 310 points higher than Hispanics and African-Americans.  Asian-Americans' average scores were 140 points above Caucasians.  Ivy League schools have long confirmed that they practice affirmative action to boost Hispanic, African-American, and other "under-represented minorities", which would explain the score gap between Hispanic/African-American applicants and white applicants.  But all have strenuously denied penalizing Asian Americans in any way, which makes the SAT score gap between Asian-American and White applicants awkward to explain.