Guest Post by Joe Guzzardi
The National Resident Matching Program(NRMP) is a nonprofit, nongovernmental organization created in 1952 to place American medical school students into U.S. teaching hospitals’ residency training programs, which are mostly taxpayer subsidized through Medicare funds. Since its founding, NRMP has expanded its mission to place qualified non-U.S. citizen international medical student graduates (IMGs) into residency and fellowship programs. Although NRMP has helped place many competent foreign-born doctors, the process leaves too many American physicians out in the cold.
In the most recent match, which happened last month, 1,162 U.S. medical school seniors and 811 previous U.S. graduates did not match to a residency at a teaching hospital, so nearly 2,000U.S. grads did not get residency. Without fulfilling residency requirements, doctors can’t practice medicine.
In last month’s match as well, 4,028 non-U.S. citizen students/IMGs matched and were granted residency, bringing the total number of IMGs placed in U.S. residencies since 2011 to 31,894. The 2019 NRPM results are similar to previous years, with the number of IMGs who match each year increasing.
Although the majority of U.S. citizen doctors match, for the thousands of graduates who have spent many years obtaining their education, it can only be devastating and shocking to realize they cannot work in their chosen profession and are saddled with hundreds of thousands of dollars of student loan debt. For 2016-2017, the average cost of four years of undergraduate education and four years of medical school at a public college, out-of-state, averages more than $300,000.
Institutions that should be doing more to help American doctors achieve their life-long dreams instead work against them. That includes the powerful, influential American Medical Association which has a strong lobbying presence and actively pursues more employment-based visas, namely the H-1B and the J-1 to bring in more foreign-born doctors. Last year, in his letter to USCIS Director Francis Cissna, AMA CEO James L. Madara urged the agency to make more visas available. On its website, the AMA has posted three pages of immigration-related topics including one that advocates for permanent status for deferred action for childhood arrivals (DACA) students in medical school or already working which would represent more job competition for American doctors.
In addition to the U.S. doctors that the current process victimizes are the ill and needy in the IMG’s native countries. A New York Timesop-ed referencing the prestigious British medical journal, The Lancet, stated that the practice of luring foreign physicians and nurses to Western countries weakens the health care systems in the home countries and amounts to “poaching” and “an international crime.” Strong words, but at a minimum when the U.S. gives permanent residency to physicians from Third World countries it’s selfishly practicing “brain drain.” When health care specialists leave their home countries, their colleagues have to cope with impossible workloads that may hamper their ability to provide adequate care.
As a result of the AMA’s intensive lobbying, earlier this year the House of Representatives and the Senate reintroduced The Resident Physician Shortage Reduction Act of 2019, previously offered in 2013 and 2017. Ideally, the bill would prioritize hiring U.S. physicians. But in D.C.-speak, shortage means more visas must be issued, bad news for job-seeking American doctors.
The Association of American Medical Colleges, an organization that the AMA often cites to make its case in Congress for more visas, concluded that the nation could have a physician shortage of as many as 120,000 by the end of 2030. But the NRMP results show that American doctors available and eager to move to the next stage of their career following medical school graduation are shut out of practicing medicine.
In 2017, President Trump signed the “Buy American, Hire American” Executive Order. But to jobless U.S. doctors, President Trump’s order is meaningless. American doctors deserve top priority which an overhaul in the NRMP could provide.
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Any foreigner is more industrious, harder working, wants to pay more in taxes and is just a better human being than any American. Based on this we should displace these newly minted American physicians in favor of the better humans from across the globe.
SARC
At the root of the problem is the fact that since the early 1900s, the AMA has been in total control, and in total collusion with state and federal governments, to limit both the number of allowed medical schools, and the number of allowed residency programs to fulfill STATE requirements to practice medicine. There is 100% collusion between these groups to purposely maintain physician shortages, limit who can practice medicine, limit who can perform what “medical” procedures (birth and midwives being the biggest tyranny), and otherwise manipulate the market to maintain high salaries/compensation for services.
Until THAT issue is addressed, all the rest of the bullshit laws regarding American-born, foreign born, etc. physicians is all just lip service. There is NO REASON whatsoever for consumers to be allowed to decide who will perform what medical services for them, no reason why private, competitive, and independent agencies could not effectively “certify” physicians or others in their competency regarding specific medical practices, and no reason why recent immigrants should not be able to benefit from the training their fellow countrymen have received when seeking out healthcare services.
Force, fraud, liability, etc. all still are violations of another, and must still be maintained, but wiping out the government-protected monopoly that the AMA and “western medicine” have over the medical industry in this country is just the tip of the iceberg in restoring the required freedoms we all deserve when it comes to healthcare and our choices. Freedom is also the ONLY solution to all of the problems that 100+ years of government collusion with the AMA, bigPharma, the insurance cartel, and others, have created in the marketplace.
When I go to a doctor – I don’t want any Chink / Dot Head / SPIC – I want a white person.
And in a truly free market, you would have your choice among WAY MORE than you can now choose from. And why should someone from a foreign country not be able to choose someone of their own liking. Again, the problem is a lack of freedom, not a “more balanced” approach to government and AMA tyranny.
Obamacare basically ended the private practice of medicine. As medicine becomes more and more centralized, and his doctors become more and more employees of giant healthcare cartels owned by the banks, it all becomes about how much they have to pay the doctors.
But the system was fucked up WAY before Obamacare got on the scene. It was just yet another government response to all the problems that previous government “solutions” caused.
True
Soon there will be Affirmative Action doctors…don’t it make you feel all safe and secure?
As a physician, I know this is nonsense. It is simply a fact that there are enough residency positions available, more than enough, in fact…many remain unfilled. The problem is that all those graduates want to go into high earning/preferably all cash/no medicare fields like dermatology, plastic surgery and orthopedics, and will not list alternatives in less crowded fields. Positions in the primary care fields, where most of the need is, remain unfilled. This is, incidentially, where the foreign graduates mostly match.
It would be similar if all engineering graduates only would want to work for Google and would see all other offers as an insult to their dignity.
ANY medical school graduate could find a residency somewhere, there are more positions than graduates, some people are just too entitled and feel all their needs have to be catered to.
I’ve not seen data to suggest “ANY [USA] medical school graduate could find a residency somewhere.” Has the field of 1,162 US medical school seniors who failed-to-match this year, or some recent year, been thoroughly studied? Citation please.
Speaking as the guy ranked last in his medical school class, who went into family medicine, a non-competitive specialty.
Yes. The immigrants are stealing the jobs. Never mind that there are more residency slots than there are American grad applicants every year. Oh no. The problem isn’t with them at all. It’s with the people that don’t look like you and so don’t deserve a fair chance.
This is a mostly bullshit article. Just because someone doesn’t match, doesn’t mean that they don’t get a residency. It just means that after the match, they have to make phone calls to the open positions and get a position outside the match. Virtually no Americans don’t get a residency position. It’s only the rare idiot with personality problems that doesn’t.