I’m a doctor. I’m on Medicaid. I work as a waitress.

I just received this letter from a physician in the Unites States of America:

Like thousands of medical school graduates each year, I did not get a residency [a residency is an additional 3+ years of medical training after 4 years of medical school and is required to get a medical license]. We might as well be lepers…I did manage to get a very part-time job in the IT department at the hospital for $10 per hour.

Funny thing is that we were launching this automated refill protocol for docs so that they would be less inundated with refill emails…the IT department thought it wasn’t sufficient to have an MA or LPN make such a decision…they said at least an RN…no one wants to do it…they are all too busy…I offered to do it and they said I don’t have a license so it will be the MA that decides whether or not to refill a script. Is there something wrong with this picture or is it just me…

Anyway I have to go back to the cafe and make my living waitressing…can’t draw blood, can’t take BP or pulse nor weight or height yet the MA can and little me with an MD and a masters from an Ivy League school is not qualified without an MA license. Not enough graduate medical education spots despite a complete physician shortage…

I have tried to go abroad and be a doc but they won’t take me. I gave up until I started working in a teaching hospital as an IT intern and I realize every second of the day that these residents are no better than me…anyway even though I would do a better job than an RN, MA or LPN…one of those 3 will be making the refill decisions for our hospital and not me…my MD has to mean something right? Nope …truth is…an MA will get this huge responsibility…bc one needs a license to do anything…and I have no license…my almost illiterate cousin is an LPN in Texas and makes 4 times what I make a year…she knows nothing and even worse she could care less to know anything more than what she absolutely must know…but she will care for patients for the next 40 years and I won’t be able to take a pulse …

My issue is that I know I am better than having to mooch off the state as I am on Medicaid and I qualify for food stamps…mostly bc my loans are so high that if my dad didn’t show mercy on me I would be homeless.  

Fact: 35,476 medical school graduates applied for the 30,750 residency positions in 2016. That’s 4,726 more doctors this year who are not permitted to take a blood pressure. 

This is a fabulous video that summarizes why all of this is happened: 

___

Pamela Wible, M.D., is a family physician and author of Physician Suicide Letters—Answered. She advocates for humane medical education free from bullying, hazing, and abuse in which all medical students are valued.

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154 comments on “I’m a doctor. I’m on Medicaid. I work as a waitress.
  1. Kevin says:

    It’s sad we can’t get docs into residencies, but given that she fully disparages three levels of licensed medical staff, even calling one illiterate, I would not invite her to my hospital.

    • Pamela Wible MD says:

      I did not think she was disparaging other professions in medicine (we all have our essential roles and deserve respect for what we do). She was merely comparing and contrasting her training and lack of ability to use her skills due to a rigged system that allows thousands of doctors to fall through the cracks every year with worthless degrees and 300K debt. Shameful that medical schools and our medical establishments would allow this to happen! I can not comment on the veracity of the “nearly illiterate” comment. I certainly know people in various fields who can not put a sentence together and have trouble (as native English speakers) with basic reading and writing.

      • Allison says:

        I think the establishment fully understands that if med students were able to use their degree to qualify for other reasonable jobs after med school, there would be a real chance that there would be a shortage of students applying to fill the residency positions. I work with medical students and some of them are just coming to the conclusion at the start of their fourth year, that they really don’t want to practice medicine, but they don’t feel like they have any other options. I find this to be very sad.

        • Pamela Wible MD says:

          Terribly sad. Medicine has lost it’s way. Sucks the souls right out of these highly motivated bright ad compassionate med students before they even get out of the first year or two of “training.”

        • Nicholas Marotta says:

          Dont know about the states but in the uk dictors are sought after in various fields eg management consultancy

      • Curious dude says:

        Why are you talking about yourself in the 3rd person? Also, What were your step scores?

        • Dantalion says:

          She isn’t. At the top it says:
          “I just received this letter from a physician in the Unites States of America”
          She’s just publishing the words of another, so naturally it would be in third person.

      • Elise Luu says:

        I feel sad for this medical student and the other one who did not get into the residency.
        However, Pamela should think of how many students struggle to get through medical schools, and can’t get in residency or get a jobs. If that was you, you will be crying so hard. I agree with the student. I am sure that he/she has more knowledge than the other employees at the hospital. But the Hospital system in America SUCK. they chose people base on their appearance, and relationship with the employees. I also know that MD preceptors have favor and give more point to white student, especially white male. If they are Asian or black, or etc, they are tough to compete with white male student.
        Pamela mentioned about people who can not put a sentence together and have trouble. Sorry Pamela, I knew students who are White American born in the USA, and they have tough time passing the National board exams or not passing even one exam after graduating the MD school. In the contrast the English as second language students can study hard and pass them.
        In the conclusion, I hope that this student will keep trying to get into the residency. If it is your goal, keep trying so hard to reach it. I was born and raised in Asia for 18 years. And I can finish school in America to be a doctor, I am sure that you can do it. Just Dont Give Up.

  2. Elizabeth Faraone says:

    Cuba would probably take her as a resident.

    • Xtine says:

      Doubt it, considering imported Cuban MDs are a large part of the problem eating up American residency spots.

      • Jennifer says:

        Cuban doctors are paid by the state an average of between $30 and $50 per month for their services so if they could leave I am sure they would.. Cuba trains almost 20,000 foreign doctors a year (more than the US actually)

  3. Carlos Coello says:

    Omg! That’s extremely scary and disappointing. At some point in my life I was in the same situation. I’m a IMG, after several years doing all kinds of jobs, including serving in the military, and a couple of failed attempts, I managed to past the dreaded medical boards (USMLEs). I thought it was my ticket to success. Sadly, it wasn’t. Even thought my scores were within a decent range, I couldn’t match for any residence, I never got even a brief interview, nothing, nada. So, after a few years of frustration and while working for a cardiologist taken EKG, vitals, and occasionally even given some general medical education to his patients, I said to myself, “enough is enough”. Not more begging to get accepted into this marvelous but failing profession. I said failing not because the thousands of applicants that for whatever reason don’t match, but for the leaders and higher ups who, despite of knowing about the precarious situation of the medical situation in the country do nothing to solve it. So, I decided to go back to school and after completing the core requirements, I applied to PA school, and thank God I was accepted on my first attempt. I’ll start my PA program in about 3 weeks, and in two years, God permitting, I’ll will graduate and right after that I’ll get my medical license to practice medicine as a Physician Assistant. I know that this path won’t work for every single physician out there, whether he/she is a US or a International medical graduate. But it will work for me.
    Thank you Pamela for this blog site, and thank you to the courageous doctor who wrote this article. Don’t give up, you will get a match. Check all of your options, get a quick license in phlebotomy or EKG (it takes about 2 months), so that you can get your foot on the other side of the door. I’m sure that once doctors see how great you are, they will do whatever it takes to get you hired as a house officer, or maybe a “unlicensed medical assistant”. If you live in NY, you can contact me. I know a couple of doctors that may be able to hep.

    • MM says:

      Hi, how can i reach you?

    • Donna Shelton, PA-C says:

      I am a PA and am glad you are embracing the PA route to practice medicine, but I see so much irony here. I was fortunate to be mentored by the doctor who created the PA profession, Dr. Eugene Stead, Jr. He firmly believed PAs should be fast tracked into residency programs if they choose to become doctors. He constantly called out medical schools for being greedy and not having the integrity to allow PAs to complete such a program. You are the first person I have heard of who will become a PA after completing medical school. I think it’s absurd that you don’t have a path to become an MD, but greatly admire your desire to practice medicine despite the crap you’ve dealt with. Well done you! You will be the perfect candidate for opening your own Ideal Clinic, which by the way, Dr. Stead envisioned for PAs. He felt we would be successful in owning our own practices.

  4. C Wight says:

    While I agree wholeheartedly that this is indeed a sad and useless situation, I find it disturbing that the author feels it is necessary to say derogatory and mean statements about her own cousin. Couldn’t she just reference her anonymously?

    • Pamela Wible MD says:

      She did not write this knowing that I would request to publish it. In keeping with the original tone of her letter she agreed to maintain the overall feel and emotional content. I would focus on the serious systemic issue at hand that keeps skilled doctors unemployed and patients without the care they need during a physician shortage. I’m sure we all have relatives that we could frame in similar ways during moments of frustration.

    • Jeremy says:

      Why are a descriptive statement (“nearly illiterate”) and an observation (intellectually incurious) derogatory?

      • Pamela Wible MD says:

        Just descriptions. I’ve met a lot of people who lack curiosity and motivation. These are actually very common traits among many employees of large health organizations I have worked for. In fact, organizations often prefer the don’t-ask-any-questions, stay-in-your-cubicle worker bee and are complicit in creation of these folks. Of course, our education system graduates people every year who are nearly illiterate——especially in poorly funded districts. These are just the facts.

    • Dr John says:

      Try going to medical and having your license taken away and then having the physician “health” program block you from getting it back. Can make a person kind of bitter. Many physicians with licenses are bitter too. I would love having this Doctor in my residency program, because she understands the stresses of life and is not interested in being part of the problem. I know that suicidality among physicians who have lost their licenses is even more frequent than in the general medical cohort, which itself is quite high. The solution for me has been to be grateful, for family, for my ability to help people during an 18 year career, waking up each day alive, for the gifts, ability to work hard, creativity, intelligence, and others which allowed me to be a flawed and human but good Doctor. Thank you for your efforts Pamela and feel free to give my email address to MD’S without a license, as I feel I can help them.

  5. RAB says:

    This is very disturbing. When in fourth year of medical school in 1970, I was so discouraged that I didn’t enter the match program. I was thinking of dropping out. My brother encouraged me to at least get the MD and then “do something different”, but I’d at least have a degree as reward for many years of university. I did decide to finish, and then realized I should do an internship to expand my future options (general internship, not residency, is what first year after med school was in those days). I contacted about 9 or so little hospitals in Canada and the US a couple of months before graduating. I never wanted a high powered institution. About 7 of them had a space or 2 left, 3 in the Bay Area actually. I was quite stunned they wanted me. Anyway, I accepted one and did the year. I am puzzled that there would be more physicians graduating with MD’s than there are spaces for them to complete their education. When did that start? I did have an interesting career, and rewarding in many ways, but I so wouldn’t go into medicine now. How discouraging. And, by the way, those being the times, I graduated with only $800 in debt. A bit different from now.

    • Pamela Wible MD says:

      I believe the number of medical school slots increased without a comparable increase in residency slots. I have no idea when this happened. $800 in debt. Wow.

      • Zuhair A says:

        The number of us graduate exceeded the slots happened around 5-6 years ago. I think there is more to the story, hospitals prefer us graduate and I know international graduate still able to secure slots. Anyway, does not change the fact students pay for 4 years then are not able to practice. In other counteries the internship is a requirement to graduate,

        • Pamela Wible MD says:

          Oh, internship required and then you can practice independently in other countries? Which ones?

          • Jermaine says:

            Jamaica is one such place. Feel free to stop by and take in the sun, beaches and patients. But then we are facing a similar problem, graduating more doctors than internship spots

          • Karla says:

            In the US you can practice independently after the intern year and USMLE step 3, because after those 2 you can apply for an unrestricted license in that state. The problem is that there are not enough jobs for General physicians.

  6. Dave says:

    Calling it “mooching” to take medicaid and food stamps, especially when most such folks are the working poor just like her, doesn’t really do much to raise my sympathy levels. Perhaps that and the general attitude that many others have pointed to in the comments has something to do with why she didn’t get the residency.

    • Pamela Wible MD says:

      I think SHE feels like she is mooching. Others with true needs certainly require government assistance. She does not if she could get a job as a doctor. I do not believe she is suggesting others are mooching. She is speaking about herself and her predicament. Please give her some compassion. She is extremely frustrated and screwed over by the medical education system. Don’t lose the message of this article in her words of despair.

    • Bat Nabas says:

      I agree with your observation. I also think that everyone that graduates does not deserve a job. I believe that of all careers…..some people are not worthy candidates. I don’t know her qualifications or lack thereof. But I do know that work is an opportunity not an entitlement in all fields.

  7. Michael Gonzales MD says:

    At the same time that this disgrace is happening, large hospital and clinic mega-corporations are hiring IMG’s from abroad with work visas for the US. This allows the employer to have more leverage over the doc they employ. For this reason they would rather have such an employee than have a US grad who can’t be threatened with visa cancellation. More residency slots need to be created ASAP for US grads

    • Thomas Bond, MD says:

      I have to disagree with Dr Gonzalez. As a faculty Attending physician at an academic medical center, I have to state that some teaching hospitals especially inner city hospitals are faced with difficulty recruiting American Medical Graduates. They have to recruit IMGs from abroad who have excellent academic credentials.

      Yes, some IMGs have been recruited on work visas but most of them have high academic caliber. Those IMGs have helped maintain satisfactory Board Exam pass rates at around 70% for the American Board of Internal Medicine (ABIM) examination for the inner city hospitals (This is something that the American doctors who have graduated from the international medical schools cannot achieve). Without those brilliant IMGs, those poor inner city hospitals will not have satisfactory ABIM pass rates and will be subject to accreditation withdrawal by the Accreditation Council on Graduate Medical Education.

  8. Doro says:

    Ask this…why should someone who completes medical school have to go back to school to become a P.A.? The schools are just money makers! Just as a DPT can’t get credit for the very same classes they take as medical students. Everything is a racket!

  9. Melanie says:

    What is an MA license? Wouldn’t she be able to attain this license fairly easily, given that she’s already done through medical school?

  10. Vera says:

    I’m sorry to be a bit cynical here but I do wonder why she couldn’t get into residency… Perhaps knowing the red flags we would not be so sympathetic? Yes there are more graduates than residency spots but at the end of the day you can always reapply and there ARE other options such as preliminary spots, occupational medicine residencies, research, etc… I just know many with serious issues on their application who eventually get to practice which makes me wonder. Sorry if this is all insensitive but the article came off a bit elitist and self-victimizing

    • Pamela Wible MD says:

      Well please keep in mind this was written to me late at night as a letter by someone who was struggling (and even suicidal). She has agreed to have me publish this but I wouldn’t really call it an article. It’s a letter by someone who has been pretty screwed over by the medical profession. I’m sure there are always more details that I am not privy to. I’d like to deal with the issue at hand which is the huge mismatch of numbers of grads and match spots. Seems criminal to me. Take 200-300K tuition from 4,726 medical students over 4 years and then say “good luck, no residency slots available.”

      • Vera says:

        Point taken. There are always multiple sides to every story. The competitive nature of our field makes it hard to have sympathy and at times, as much as I try to stay open minded even I struggle to see the bigger picture

      • nd says:

        Nowhere in the world a graduate education is as expensive as in USA. I can’t imagine people leaving with the dept the size of several houses to pay for school. AMA is trying to sit on 2 chairs at the same time, satisfy US AMG’s to get residency and license to practice paid tremendously inflated salaries and attract indian/pakistani/saudi doctors to pay tons of money to the match and get them spots and then practice for 10X what they would be paid back home. Well doors are closing this or next year for IMG’s with the proposal of comprehensive visa reform introduced to the senate to cut J1/H1B visas. It is just question of time. Interesting to see what AMA next step would be…

    • Bat Nabas says:

      It did

  11. Lindsey says:

    “Even though I would do a better job than an RN, MA or LPN” and “my almost illiterate cousin is an LPN… she knows nothing” ….honestly, are you joking?? This attitude and arrogance from a brand new, totally green doctor, who was not chosen for a residency is unacceptable. Definitely a reason why she did not get a position, in my opinion as an ICU RN of 20+ years. I have lost count of how many patients would have been harmed/dead, had me and my RN coworkers simply “followed the orders” of brand new residents like her. 10x the dose of Fentanyl? Nope, we are not doing that. D5NS+KCl bolus to that baby? Over my dead body. Keep bolusing that patient because they still haven’t voided w/o assessing other options? Great, lets see gow jacked we can get their electrolytes. Tell me “not to worry” that my bleeding out patient’s temp is 32 degress and that the bair-hugger can wait? Do you even understand the most basic mechanism of blood clotting? You just told the 8yo who just found out her sister died in a MVA to “stop crying” because you don’t have the patience, compassion, or decency to let a child cry? Get out of her room and we’ll have a chat. Doses of Vefuronium ordered on a non-intubated, conscious patient for “arterial line placement” …. do you even understand what that drug does?? I could go on but i’ll stop…

    All from green MDs. Arrogant, green MDs with a lack of appreciation for what other, i’m sure in their eyes “lowlier” medical proffessionals do. Knowing and recognizing what you do not know is just as important, if not more that being confident in what you know. And this author seems to exhibit ZERO of that mentality, and berates other medical professionals who have worked hard to get where they are and assumes she with he degree and zero experience could do a better job. Those new doctors, along with new nurses who have this unchecked arrogance are the ones whom are the most dangerous, the most at risk for making large mistakes, and the ones organizations purposefully do not hire.

    Whoever wrote this has a lot yet to learn…. healthcare is a team effort, and you value the experience that each member brings to the team- regardless of the letters after their name. Decency, kindness and humility will get you farther than you think, and the writer of this seems to lack in those qualities- absolutely not suprised she is in this situation.

    • Pamela Wible MD says:

      Lindsey I am grateful that you have been looking over the shoulders of green MDs and really appreciate your intelligence and willingness to do the best for patients and educate those of us who are in error. Thank you! It IS a group effort. Again, this letter is written by a woman who is on Medicaid and would be homeless (with a medical degree she can’t use) and she is in a state of terrible despair and even suicidal. A dose of compassion for all would be helpful here.

    • Max says:

      That is an awful lot of judgment about this person’s character inferred from a few sentences written from the depths of despair. What I see is a person with four years of dedicated professional training throwing her hands up and wondering why she isn’t allowed to do any of the tasks that those with considerably less training are allowed to do, all else being equal. I don’t think she was trying to pick a fight with your profession. We can probably agree that allowing an MD to handle script refills isn’t too much of a stretch. She is not demanding to be an attending physician now, or to be given carte blanche to terrorize the wards in other ways. By having an MD, however, it is understood that you can do the basics: you can obtain vitals, take a history, perform a physical, maybe draw blood and do some suturing. This is simple stuff that any MD ought to be able to do with some supervision in order to gain that all-important experience that they cannot possibly gain any other way. Should this person be alone on-call in the ICU? Nope, absolutely not. Should her training afford her a little more respect and a few more privileges than the high school senior working part-time at the kiosk next to her? You bet it should.

      What concerns me the most about your comment, however, is the all-too-common “us versus them” mentality that you lay out in such compelling detail, and which does terrible damage to any team dynamic you may hope to have in your workplace. Please step back and let me characterize the experience of the recent med school grad for you. Too often, internship and residency is a psychologically crippling, thankless job taking 80-100 hours a week (because for many, work hour restrictions are a myth), and I would assert that a far greater number of “green MD’s” have ZERO confidence than those who have too much. They are suddenly in charge of decision-making, documentation and sometimes other ancillary services such as social work and case management for 8, 10, or more patients at once. They have several layers of supervision insulating patients from any inexperience they possess, and I can tell you from experience that even the best intern receives criticism far more frequently than praise. Most days they probably do feel like That Stupid Doc Who’s Trying to Kill the Patients, because that’s what they get told from all sides. Having nurses, or techs, or whomever watching them like hawks and readying patient safety reports doesn’t do anybody any favors. If your facility is truly full of arrogant, cavalier young physicians, I’m sorry, but I suspect it isn’t. I would venture that most would benefit greatly from mentorship and some compassion from someone experienced like yourself. The wall you’ve clearly built between yourself and them, however, isn’t helping anyone.

      • Pamela Wible MD says:

        I think there is an overall lack of awareness about who doctors really are. Most of us are idealistic humanitarians who just wanted to help people and our souls are crushed during training (as well as our back accounts with 300K debt). Compassion for our medical students and doctors would go a long way. If you want to learn more about what it is like to survive (or die during) medical training please read my book: Physician Suicide Letters—Answered. https://www.amazon.com/Physician-Suicide-Letters-Answered-Pamela/dp/0985710322/ref=asap_bc?ie=UTF8

      • klyaksa says:

        Thing is, I am trying to understand what would have to happen for an American medical school graduate to repeatedly fail to match anywhere. I can only come up with two possibilities – either she was too inflexible in her choices (i.e. refused to consider options beyond certain specialty/location) or there were some major issues that were apparent to everyone around her. Given the tone of the letter, I suspect it’s the latter.

      • K DENNIS says:

        Thank you. As a physician I am tired of reading these “us” versus “them” responses.

      • Phoenix says:

        Wow. This was exactly my experience as an intern. I was quite aware that I knew nothing, and yet I had a great deal of responsibilities, and no mentorship. I think intern year is just not constructed in a logical manner.

      • Dr John says:

        Sorry you feel that way. I imagine it hurts. When I have tried to criticize others using insulting or condescending language, I have often come out looking worse than the person I was criticizing. I wonder how your post came across to those”green” interns and nurses. I recall being in that position myself. I sought out good, kind nurses to help me and give me advice, not nurses who berated me for being human and making mistakes. I’m sure you were a new nurse once…

      • Dr John says:

        Well said for someone I hope made it through it without killing too many people with his arrogance and who I hope is happy in his current situation!

    • Lauren says:

      As an ICU nurse previously, and now currently a Certified Registered Nurse Anesthetist, I am so glad to see this comment, as I was already planning on how to write one very similar to this. I was completely appalled to hear this person put down other practicing medical professionals from the team and say she could clearly do a better job, having no residency training. She has a lot to learn. And that is not coming from someone with “no compassion.” That is coming from someone being realistic.

      That lack of realism and over-confidence is going to get a patient killed one day.

    • Dr John says:

      Sorry you feel that way. I imagine it hurts. When I have tried to criticize others using insulting or condescending language, I have often come out looking worse than the person I was criticizing. I wonder how your post came across to those”green” interns and nurses. I recall being in that position myself. I sought out good, kind nurses to help me and give me advice, not nurses who berated me for being human and making mistakes. I’m sure you were a new nurse once…

    • John P says:

      Lindsey,

      You bring up a lot of good points.

      The problem, however, isn’t green MDs. It is green MDs who are not adequately supervised or mentored. Shame-based learning is very widespread in medical education and those green MDs you mentioned are often threatened with bad evaluations, rotation failures, and eventually termination if they frequently admit to the doctors responsible for evaluating them that they don’t know something or that they need help because they’re in over their head.

      So those green MD are faced with a no-win situation. Either they risk poor performance, failure, or termination if they can’t handle problems themselves from day one or they try to handle things themselves, often compromising patient safety in the process as you correctly surmised.

    • Greg says:

      Obviously, Lindsey is the troll. Please ignore her. She sounds like she can handle anything without an MD.

  12. Gastrodoc says:

    Clearly she has a bad attitude as many have commented above. How else would one explain an MD from an Ivy League school as she has mentioned in her letter, not getting into a residency.

  13. Dave says:

    The whole story isn’t here. What residency spot is she trying for? Did she fail Step 1 multiple times? I know there are few family practice residencies in the midwest that never get filled. If you don’t match you have to be on that phone non-stop. Plus there are outside-the-match positions. Residents quit or get kicked out often. I KNOW many surgical internships (1-year only) are open. Do this and pass step 3. Maybe she is a victim of a medical school that pushed her through just to get her money knowing that she’d never make it. You aren’t making your resume any better waitressing! Get in there and get on a research team. Volunteer, anything. Yes it sucks but sounds like she gave up?

  14. Heather says:

    So, do you only ever get one chance to enter residency? The tone of her piece seems to suggest that she will never again have that opportunity.

    • Pamela Wible MD says:

      She is multiple years out from med school graduation. Extremely slim to nearly impossible chances the further you are out of training.

  15. Sam Sonic, MD says:

    I understand the frustration she is having, but it is a little misplaced on people who got degrees to do exactly what they’re doing. There is an issue in the way we do residencies when foreign medical grads are taking American residency spots away from American medical grads. Priority should be given to our American grads since a) they did their schooling in the country they are applying for residency in and b) paid a lot of money for their degree whereas some foreign grads are paying pennies on the dollar for the same degree. This should also apply to DO residents. MD residents are not allowed to apply for DO residencies, so I don’t understand how DO residents can take MD resident spots.

    Especially given that there are more applicants than there are spots, we should let DO and foreign medical grads apply only AFTER American MD grads have filled residency spots first.

    • Cameron Samson says:

      I think you need to do a little more research on your understanding for residencies. Both MD and DO residencies are merging. In 2020 all US medical students (MD and DO) will be able to match all residencies in the US. So yes, MD’s can match DO residencies.

    • Jennifer says:

      Sam Sonic let me bring you up to date. ACGME is merging DO and MD residencies and therefore MD’s will be able to apply for DO spots. By 2020 it will be fully inplemented.

  16. Susan Neely says:

    Wow..sounds like me except that my degree is in pharmacy and I am old. I am a cleaning lady.
    God bless her. Has she looked into anything like NHS or a NPO?

    This is really horrible.

  17. Valerie says:

    So sorry. I resigned a residency due to family problems and had to reapply. So I worked a year while reapplying. I wanted a job as a case manager or in utilization review as I was a physical therapist before residency. I let my license expire. I could not get those jobs because I wasn’t an RN, even though I was more than qualified with my background. I had to reapply for my PT license to find a job to make enough to support my family. They made me jump through hoops to reinstate my license because I hadn’t been a therapist for 5 years. Medical school didn’t count. Stupid rules outweigh common sense.

  18. lulugirl says:

    I can sympathize being an underemployed PhD myself, but how about rural hospitals? Are these an option? I read all the time about rural shortages of doctors.

    • Pamela Wible MD says:

      They all require a state license (impossible without at least one year of residency). To bill insurance most plans require that you are board certified/eligible (which means you completed a residency). Terrible.

  19. Richard Hendrix says:

    Where did she go to medical school?

  20. Henry says:

    I am physician. Although it is rare there are medical students that don’t match into a residency. It would be interesting to know if she applied to any scramble spots, and also further examine what the circumstances of her not matching were.

    • Pamela Wible MD says:

      Agree. That would fill in some details. But still the numbers are appalling. There is a mismatch here:35,476 medical school graduates applied for the 30,750 residency positions in 2016. That’s 4,726 who are screwed. Thoughts?

      • Thomas Erickson says:

        There’s no mismatch. The numbers listed above are technically accurate but very misleading.

        There are still many more US MD residency spots than US MD/DO graduates annually. Yes, there were 35476 active applicants in 2016, but only 21169 were US MD/DOs (18187 MDs and 2982 DOs). There were an additional 2438 DOs not in the NRMP. Anyway, 23607 US MD/DOs graduated in 2016. The remainder of applicants in the NRMP were international physicians. Even if you include all 5323 American grads of an international school and every DO matched to an MD residency (which is essentially where we’ll be by 2020), there were still more MD residency spots than American grads.

        No US grad is being excluded based solely on availability. Certainly, some American grads don’t successfully match. But let’s call a spade a spade; it’s usually either a performance issue during medical school or poor choices when choosing specialties, selecting programs, and ordering rank lists.

        Right now, the US relies on international physicians to fill its MD residencies. I’m very glad for this, because the US is able to attract many excellent clinicians. However, the US does not owe international graduates a spot, nor could we accommodate any/all who apply. Besides, what is the magic number above US graduates that’s appropriate?

        Essentially, the question of the total residency spots needed to alleviate the current US physician shortage is separate from the number of American graduates US schools produce every year (at least at this point). Let’s not confuse the two.

        • Pamela Wible MD says:

          So what do you suggest in the case of the grads who have not matched in 3-5 years since med school? I’ve been speaking to several. They want to be in direct patient care. Curious how you think they should be added to the workforce.

          • Thomas Erickson says:

            I think you’re asking one of two things: 1) how could these individuals be enrolled in residency training, OR 2) how could they practice without residency training.

            The first essentially revolves around the individual issues that prevented them from matching. These deficits would need to be addressed by each candidate. Some can be altered (specialty and program choice, interviewing and interpersonal skills, work/research experience, etc.) while others cannot (alma mater, USMLE scores/attempts, prior NRMP applications). Each individual would need to address their deficits and improve what they can. I would hope their medical school would assist with this. The following will sound harsh, but my goal is to be realistic: if a graduate does not match despite 3-5 attempts, are they appropriate candidates to be independent physicians? If someone does not successfully incorporate feedback and produce adequate change over that time period, would they be able to do so in residency? Or afterwards? I understand I am simplifying the process, but it does apply to overwhelming majority of applicants.

            If they unable to match, the only other way for them to practice would be without residency training. By necessity, this would involve alternative training (like the “assistant physician” program in MO) or simply allowing MDs to practice other non-medical aspects of healthcare. I don’t personally think either of these are reasonable options to produce well-trained, independent physicians.

            Overall, I don’t have an easy answer to how they can be added to the physician workforce. However, I will reiterate: I do not believe these individuals are not victims of inadequate residency spots.

          • vxc says:

            Is it possible that these people should not be in direct patient care? If her scores were average, then she would have gotten a residency. Maybe a year or two of not matching can be attributed to the “system.” But consistently not matching for years? Nope, there’s something she’s not telling.

          • Pamela Wible MD says:

            Even if we don’t have all the details, the question remains: Should she be able to work at the level of an NP or PA? Take a BP?

          • LK says:

            Hello. I am on faculty, going through applicants for residency. Unfortunately all MDs are not created equally. A US medical school MD is weighted more than a nonUS medical school MD. Usually, students who can’t get in to a US school applies (usually to a Caribbean med school – ie Ross, St George, AUC). Unfortunate graduating from those medical schools do not guarantee a residency spot. You must do well on USMLE Step 1 and 2. They are given months instead of weeks (for US students) to prepare for the exams. So below average scores start the cascade of red flags. They need to do great clinically. Not observerships where you just watch and not take care of patients. And many only have observerships. You can’t take step 3 until intern year so you are unlicensed to practice medicine until you pass step 3. Which is why this lady can’t get a clinical job. The clinical rotations for a lot of Caribbean schools are not as robust as US med schools, so applicants are scrutinized for academic readiness (can they pass the written and oral boards after residency). Unfortunately many don’t have the grades or the scores, making them an academic risk (even if you get a residency spot, you won’t graduate in order to practice). Unfortunately MD from other countries fare worse because we don’t know the education system (ie Romania, Antilles) plus language barriers (USMLE only in English). I have seen those applicants reapply to US DO schools to improve their grades and scores to get a 2nd chance….and even then, some still don’t get a spot. If they want to care for patients, going through a PA program is great. However, coursework is varied and just because you get an international MD degree, it doesn’t guarantee quality of coursework which is why it is repeated. But if they are qualified, the 2nd time around should be easy and get a PA job. But debt is crazy, and some may balk at another round of debt.

            I know of several foreign MDs doing the PA route. It is humbling (bc they have a MD) but residencies want their board pass rate to be high and usually if you don’t match, there are red flags in the application.

            PA jobs have a lot more flexibility than MD jobs (ie can be part time, switch specialty if you don’t like it) that also has it’s own benefit. Some PA salaries also pay more than primary care / pediatric / family practice MD salaries.

            Others have gone for MBA in health administration.

            If you can’t incur any more debt, getting a union job as a phlebotomist or MA or environmental or laundry (anything that had tuition reimbursement)in a hospital is key. My office environmental lady (MBA in her home country) got her phlebotomist degree, switched jobs, and taking courses paid by the union for more advanced degrees. My patient was a home health aid for 8 years while she got her US MBA.
            Hope this helps clarify, and give some direction to those who are looking for alternatives.

          • Pamela Wible MD says:

            Thank you!! Very helpful.

        • Dave says:

          Wow this article was misleading, I heard your facts before but THANK YOU FOR SHARING. Pamela Wible needs to update the post to reflect the truth. If we are to have an honest discussion about MDs that cannot get into residency (probably academic performance in this case) and what else you can do with this degree, we need to present the facts and approach this problem like doctors.

          • Pamela Wible MD says:

            Added a video that should help with residency bottleneck facts. There are students who have graduates from med school who do in fact work at minimum wage jobs and are on food stamps and Medicaid. These are the facts.

  21. Michelle gohl says:

    She makes a valid point. It’s not a great system and is a huge stressor for MDs. But, as an RN, I must say, Her statement,”I would do a better job then an RN,MA, or LPN.” is just the kind of attitude that hospitals steer clear of now a days. There has been a clear change in culture over the last 5 to 10 years. That devaluing the rest of the people on the team is not good for moral or the patients.

    • Pamela Wible MD says:

      Again, she was writing this late at night to me in a rant-type email out of complete frustration probably after a few drinks and suicidal. Try to put yourself in her shoes. Please.

  22. Millie Boyd says:

    I think that this post is taken way out of context. The author is telling her story without giving all the facts needed to understand why she didn’t match. To be honest getting a residency requires that applicants be competitive since the government has refused to increase residency numbers and allowed inflation of med school admissions. To really understand her situation we need to know where she went to school and her scores on the usmle. If you didn’t pass the board exams or completed school thru a less reputable program you face higher chances of not matching. Every program talks about the importance of the step 1 exam (which I agree shouldn’t be a main decision factor but it is) I have heard many stories such as this and usually there is an undisclosed factor that affected their application specifically outside of the general issue with the number of spots. Completing medical school does not guarantee you a residency, you do need to do well. Another issue is that students apply to only high end residencies and don’t match as they are not competitive enough, again not the system that is an individual issue.

    So I would suggest not posting such articles with such limited information that gives a really poor image of post med school life. Also please state your sources for numbers and stats on residency applications and who is all included in that number. It is not first time grads only in the US.

    I feel this article is complaining and wanting inappropriate attention to the issue of residency positions in the US. It does not meet its goal and distracts from the truth.

    Most who do not match do not work as waitresses. If you really have a masters there are many administrative positions and other fields in science and research you could work in. The author seems to be selling herself short and seeking somewhat of a pity party ( honestly would be interested to know her usmle scores in context to her claims)

    Just my thoughts. But not a great example of a non matched student.

    • Pamela Wible MD says:

      True. I do not have all the details and we could get deeper into her story. The stats I quotes came from Medscape here: http://www.medscape.com/viewarticle/866044?src=soc_tw_160722-pm_mscpedt_feat_poll and a GIF graphic that I posted on my Twitter page from Medscape titled: The MED SCHOOL BOTTLENECK

    • LK says:

      Would like to add not all master degrees are created equally. Most schools have a masters in sciences which is like a post bacc programs for those who need pre-med courses. Or their undergrad GPA is low, so this gives them a second chance to improve those course grades.

      Unfortunately, it is a step for people to apply for med school (rehashing of premed courses). If you don’t do well in this MS program, you don’t get into med school and just added 2 years of debt with little skills added.

      People with health science backgrounds can sometimes get lab jobs (to do research). But it isn’t like a public health, education, or business masters.

      There is nothing wrong with accepting Medicaid and food stamps. It is a safety net for a reason.

      There are some single physician moms who rely on this safety net, even AFTER graduating from residency because of med school debt, cost of childcare while they work full time, because their physician salary is not sufficient to cover housing/ childcare/ emergency healthcare costs etc….especially primary care colleagues. … Or those who have children with special needs.

      • Pamela Wible MD says:

        Does anyone think this is a problem besides me? There are some single physician moms who rely on this safety net, even AFTER graduating from residency because of med school debt, cost of childcare while they work full time, because their physician salary is not sufficient to cover housing/ childcare/ emergency healthcare costs etc….especially primary care colleagues. …

        I mean I’m glad the safety net is there but why should med education be so expensive that one would have to go on Medicaid and food stamps as a doctor????

        • CE says:

          I am a single mother primary care physician and while I have not had to resort to Medicaid and food stamps while employed as a physician I can say that I am only a couple of paychecks away from this. Primary care pays pennies when compared with my student loan payment and other bills put together. I’m not living an extravagant life spending recklessly and not attempting to save either for those skeptics. But pay gap between specialties is a whole other topic.

        • NN says:

          My best friend is an Internal Medicine physician who was on food stamps and WIC. After her divorce, her husband quit his job and went back to school to get his Master’s degree. He was not required to pay alimony as she made more money than him, he did not pay child support until the court case was completed, stopped paying for his child’s private school(public school system one of the worst in the nation) and she had to pay for both her own and his attorney. They had filed taxes separately but because they had been married, any money he owed was taken from her IRS return. Then she still had loans from medical school to pay. I had to send her money just for her to put a deposit down on an apartment. The assistance got her through a tough time so that she could get back on her feet. Life happens to docs also….

  23. Kristine Warnecke, BSN, RN says:

    I usually like your articles a can relate to them, this however I wish I could unread. This person is not a team worker which is probably why she was not matched to a residency. As a RN I wouldn’t want to have to work with that attitude.

  24. Stacy Lahti says:

    I have been involved in post-graduate education for several years. We have always had at least 1+spot in family and internal medicine residencies available at time of scramble. I understand that this was a letter written by someone in distress but I am very disturbed by her comments. I too would like to know the backstory because we have deliberately not offered spots to candidates based on board scores as well as interviews (poor attitude, etc). Even though this was a letter to you, she comes across as having a superiority complex instead of a team approach. I do agree with you and have expressed my concerns with the number of medical schools opening in the USA but the growth of residency programs has not kept pace with the student numbers. Having said that, I also know of several residents that did not match into a desired specialty and had. To choose between reapplying the following year or choosing another residency path. I have trouble believing that she could not find any residency in the USA within a couple of years. We have suggested to a couple of individuals who were weak candidates and struggling to find spots to take an unpaid position (like an internship) for a year and reapply as this showed dedication to the pursuit of their education and strengthened their application. These individuals were encouraged to also try and find a position within a hospital working in some capacity. I also struggle with her credentials and inability to find a job with a 4 year degree plus masters (from Ivy League school)–did she get worthless degrees and if so, that is her own fault. I have encouraged those interested in pursuing a medical career to obtain a degree in a field that could provide a liveable income in the event that they were not accepted in a post-graduate medical program whether it be medical school, PT, pharmacy, PA, etc

  25. TAG says:

    It is probably depressing and despairing to watch her loans increase. As time goes by, the loans get so high, it seems even more impossible. At the same time she feels worthless and unrecognized for not getting residency. I suggest that she get a job that lets her get public service loan forgiveness. These kinds of jobs could be in research, or as an MA, or non-profit industry, county or state job. Something that feels better than waitressing is out there and will pay her bills. Some have great benefits and super warm and human co-workers who love their work and their lives. Then, get to sleep every night by 10:30 pm, learn to meditate and do it daily, spend time in nature as much as possible, not take substances, and RECOVER her mental health. It could take her a long time and it will be more gratifying than trying to do something that feels rigged against her.

  26. VoiceOfReason says:

    How about if the powers that be… whoever those shadowy folks are… change the requirement from 3 to 2 years for residency. Is there a reason for the magical number 3? Is is necessary, is it warranted? Make it shorter and free up space. After 1 to 2 years of residency, I think we can agree that MDs are plenty well cooked.

    • Pamela Wible MD says:

      I agree especially for outpatient primary care. Even one year may do. The shadowy folks are, of course, against this.

  27. Pamela Wible MD says:

    This is a fabulous video that summarizes the issue at hand: https://vimeo.com/77727683

  28. Joe R. says:

    The statistical “FACT” about the match rate this year is true, but it is important to point out that only about 60% of the 35,476 applicants were from U.S. graduates. According to the AMA, last year only about 250 graduates of U.S. allopathic medical schools did not match.

  29. A PA perspective says:

    Hello-
    There are several comments about how MDs are that are International Medical Graduates (IMGs) or physicians that could not find a residency ‘humble themselves’ and either work as a PA or go to PA school.

    As a PA and program director who screens thousands of applicants to PA school- this is not an easy or realistic process.

    First- I’ve had multiple IMGs in PA programs and most struggle- attitude, language, outdated MD coursework, and yes, U.S. courses can be much more difficult (PAs train in the MD model). So to expect to walk in and excel in a PA program is not the usual case. With that said, I am admitting an IMG this year who is a standout- meets all the prerequisites, dedicated and passionate to serve in a primary care setting (but can I stress that the PA profession is looking for leaders and humanitarians that appreciates/celebrates all the members of a healthcare team… RN, MAs, etc.)

    Last point, obviously, MDs who don’t match can’t ‘step-down’ into a PA position. We teach them to work with physicians so the training and mindset is different. We also screen for the best and brightest to come into our profession– we look for professionalism, leadership, empathy and evidence that a person can work in a diverse/complex medical setting. A lot of PAs have worked as MAs, techs, RNs, etc. before PA school in order to bring forward the qualities mentioned above.

    Finally, most PA programs employ physicians as faculty- teaching and mentoring..have you thought about working in a PA program?

    A

    • Pamela Wible MD says:

      Thank you so much for the PA perspective. Appreciate it! 🙂

    • Pamela Wible MD says:

      One more thing I will add that really gets in the way of what this gal can do next is that a huge number of med school graduates leave training with new mental health diagnosis (anxiety, PTSD, depression, suicidal thoughts—all occupational hazards of medical training) so it is tough to sell yourself as a great applicant for anything when you need mental health care, food stamps, and Medicaid. It is appalling how we allow these people to be (mis)treated emotionally, spiritually, financially. It’s amazing to me that she is functioning as well as she is and still breathing after all of this. Doubt the veracity of any of my claims? Please read this: http://www.physiciansuicidelettersanswered.com

  30. Anita Fullbright, FNP says:

    I hope she’s looking at research options.

  31. Carl Valenti says:

    “I would do a better job than an RN”-this is a Licensed professional person who has met the requirements of licensure!License brings accountability and responsibility. As a LICENSED RN in 28 states, I strongly resent the indication that a graduate who has never touched a patient or has an apparent misunderstanding of what RN’s do (beside check errors by M.D.’s and D.O.s before they make it to the patient) for their 10 minute session, could replace the safety of a proven, licensed professional. Good luck when and if you practice, because patient care is a team effort, not a blessing from any “Ivy League” trained waitress.
    Attacking the skill of the team, because of your frustration and inability to match shows a lack of big picture thinking.

    • Pamela Wible MD says:

      She was in a state of despair and expressing her total and complete frustration after a few drinks late one night with me. I do believe she meant nobody else any harm. She has no one advocating for her so I asked if I could publish her email. I’m sure she was not fact checking every line. Stream of consciousness pure despair. Don’t lose the entire message in a few provocative sentences.

  32. Cornel says:

    Very sad .
    At the end of the day “Life goes on “.
    Try something related to medicine and keep applying next year .

  33. SVS says:

    Something about this story doesn’t make sense. Even if she couldn’t get a residency spot, why couldn’t she use her master’s degree to work? Why did she have to resort to being a minimum wage earner with her master’s degree?

    • Pamela Wible MD says:

      Are you familiar with the mental health wounds sustained in medical training? I’m sure that played a huge role.

  34. Jenny says:

    While I think it’s a shame you are not able to get into a residency program, is it necessary to put down other members of the health care team? Clearly, you do not understand what it’s like working in a hospital and with other kinds of medical staff. How are you so sure you would be better than an RN or MA at drawing blood, or doing an assessment? Did you not seek the help of these other health care members as a student? Your attitude sucks!

  35. Gunther Ruckl, MD, PhD says:

    My heart is with you, Stephanie. Only bootlickers survive professionally in this country. I prematurely retired because I found out the hard way that the reputation of a rebel is a career killer even for an Ivy League graduate. I prematurely retired. I have to live extremely frugally but I am FREE and continue to speak up.

  36. B Rogers says:

    That’s 4726 doctors that have paid over $250,000 in their education. Or at least $1,181,500,000. That’s over 1 Billion dollars spent on education that can’t do anything.

  37. Jennifer Bollen, MD says:

    Data to give the story some context. Did she graduate from a US Medical School? 96% match Did she apply for primary care? So many slots go unfilled that 48% go to students from overseas.. If she has an IVY league masters degree and can’t get a job? I know a number of MD’s who never went into practice and work in very senior positions in healthcare.

    Something other than the lack of slots was a factor.

    Although The number of United States allopathic medical school senior students grew by 221 to 18,668, and the number of available first-year (PGY-1) positions rose to 27,860, 567 more than last year and 96% of all US seniors match.

    Of the 27,860 first-year positions, 13,744 were in primary care specialties; of those,
    13,484 (98.1%) were filled and 7,160 (52.1%) were filled by U.S. allopathic seniors. Since 2012, the number of primary care positions has grown by 2,512, a 22.4 percent increase.

    BTW – technically all residents and interns are “on Medicaid” since CMS pays their salaries for 3 to 11 years of training.

  38. Sara says:

    This is a huge problem and very sad, but it’s a bit hard to agree with the ACGME solution in the video of doing this by maintaining the status quo. Residents are miserable and come out trained in a way that may or may not reflect their ultimate practice, and do currently require far more training that anyone else before licensure. But increasing the number of slots without addressing a host of other issues isn’t a good idea.

  39. Dani MSN says:

    I must confess, I’m a little turned off with this person’s narcissism in regards to other professions in the medical field. All of us medical professionals have worked very hard (including LPN’s), to serve our patients well. Maybe it’s her prententious attitude that lead to her lack of interning?

  40. John Kim says:

    Having completed MD, masters in public health, internship, residency and fellowship, I no longer recommend students to consider route of MD, unless considering to become a pathologist or radiologist…

    Rather, I recommend RN – NP or PA route.
    RN – NP or RN – PA offer shorter and practical route than MD…
    I predict that bulk of primary care will be performed by NP or PAs in the future as most of office visits for specialists…

  41. Jennifer Furlong says:

    I worked as a microbiologist in a clinical laboratory for the past 24+ years, and I agree that the US healthcare system is very broken. I just got out. In January I started a new job in research microbiology.

    I have heard rumors that some rural areas have great difficulty finding primary care doctors. I have no idea if this is true or if residencies in these areas exist, but perhaps it would be something for this young doctor to look into. Would she be willing to volunteer for an organization such as Doctors without Borders? Or the WHO?

  42. Jillian M says:

    Im an RN working on my Doctorate here NY to be an NP. This was eye-opening for me as I did not think this could happen in Medicine. I had no idea that one who holds an MD could get denied a residency. I’m so sorry this has happened to you, it seems downright cruel and I too would be beyond upset and saddened. There has got to be other options for you!!

  43. Bill says:

    Which medical school. And where?

  44. Kim says:

    This is why I urge anyone interested in medicine to get a BS in nursing and become and obtain a license as an RN before medical school. That way if you don’t get in a residency program, you can support yourself.

    • Dr John says:

      I agree, although I recommend an LPN and a few months working to get experience and learn to treat young, scared, scarred professionals starting out. More doctors could use this humility, but so could PA’s,NP’s, BSN’s CRNA’s, and many other people in healthcare who would benefit from some(a lot) of humility. I personally was a CNA before med school.

  45. Marg sully says:

    Maybe a course in humility and anger management might be of value. If you couldn’t get a job, maybe much of the reason is that you are a difficult, negative person.

  46. M. Miller says:

    As a physician I completely understand her frustration. However, I believe it would have been better had she been given the opportunity to write about her frustration at a later time and for THAT letter to be published here. A large number of the commenters cannot put themselves in her position and are focusing on her remarks about other professions rather than focusing on her problem. Much of that comes from the tone of her letter which takes away from her point and I’m sure would have been different had she known it would be published.

  47. Tim says:

    Wow is right, she obviously has no respect for MA’s or LPN’s either. Maybe if she adjusted her mightier than thou attitude she might get a job.

  48. K says:

    As a physician reading this, my impression is that there has to be major issues why a US med student from an Ivy League med school did not get a residency spot. Lots of red flags.

  49. L. Steeley says:

    You advocate for medical education that is bully-free yet you have no qualms about insulting the professionalism and capabilities of an RN.

    You might want to look at that.

  50. Ernest P. Osei-Tutu, MD says:

    Only Bootlickers survive in medicine. If you think independently or don’t cow tow or step out of somebody’s imagined lines, they will put you in your place and harm you professionally. Medicine is frought with personal politics and retribution towards physicians who are seen as not towing the line or having the courage of conviction to stand up for their beliefs. When you have Medical Boards helmed by the laity and lawyers sometimes envy towards physicians and clinical ignorance can make poisonous amalgam that harm innocent physicians brought before these medical boards and post graduate training programs for trumped up merit less charges.

    The Massachusetts Medical Board is the Most Political with a penchant for putting perceived uppity non cow towing physicians especially those of color in their place.
    “Lynching” is alive and well at the Massachusetts Medical Board but the technique has now been perfected and sanitized in the form of disseminating prevaricated and calumnies information on the internet with the sole purpose of harming the reputation of innocent physicians who cross Medical Board Officiials

  51. CarolHarlow says:

    So the system is set up to produce more MDs than there are training slots so they can actually get licensed???
    That is terrible!

    No other country will allow such doctors to practice abroad?

    What about our military?

    There has to be a way to deal with ths

    • Pamela Wible MD says:

      “Jung v. AAMC in 2003 challenged the Match on antitrust grounds, claiming that the collusion of hospitals within the Match artificially depressed wages. In response, Congress passed an explicit exemption for NRMP through the Pension Funding Equity Act of 2004, making legal challenges moot.Nonetheless, labor statistics are daunting. Per the 2012 US Census, mean earnings for 25-34 year olds with a doctorate or professional degree are $74,626 or $86,440 respectively. The AAMC mean first-year resident salary was $50,765 for 2013-2014.NRMP dodged the legal attack in Jung, but numbers don’t lie and a $23,861-$35,675 difference in salary is robbery.”

      “Economist Dr. Alvin Roth won a Nobel Prize in economics for his theory in a double-binding labor market match underlying the NRMP — but notably, academic economists like Dr. Roth himself acquire their positions on the free market, not through a match.”

      Read full article in Forbes: http://www.forbes.com/sites/theapothecary/2014/04/15/how-a-nobel-economist-ruined-the-residency-matching-system-for-newly-minted-m-d-s/#37cdfaa044d1

  52. Melissa says:

    Why did you use a picture of woman who is not a medical student/doctor/anything at all in the medical field and why did you use a picture of her without her permission? You’re presenting your readers with blog posts that are supposed to be factual but there is obviously part of this one which is not. That’s creepy because you’re a doctor and are supposed to be trustworthy.

    • Pamela Wible MD says:

      I hase a signed consent from both women in the photo which was taken in my town several years ago for a blog I wrote on health insurance. Photo has been removed.

  53. Beyond frustrated says:

    This is exactly me. I am from the US, I went to a foreign school, I have applied 4 years in a row costing me thousands in applications. My student loan company is calling me non stop-I am only 5 days late on my student loan payment and I intend to pay it. I know a ton of people just defaulting on their student loans. No one will hire me-I am an MD with no license. Doesn’t the government realize if we are allowed to work and pay off our loans and make a living the economy will improve also? Look at the numbers from the video above. If that many people have the ability to afford their loans and can pay for a car, house, travel, etc. the economy will certainly improve. I have written several senators and congressmen with an additional solution that would not cost the residency programs anything, I only heard back from John McCain who stated it was not likely feasible, but it is! I am willing to help this cause in any way that I can.

  54. Cyb says:

    Serious question: if a physician cannot do a better job in the hospital than a nurse or a medical assistant, then why are there physicians in the hospital to begin with and what exactly is the medical doctoral degree’s purpose? I mean I get the idea of not rubbing it someone’s face, but I thought it was simply factual that 8 full academic years of university education, 4 being at the doctoral level is a superior education to 9 months of vocational training (MA) or 4 years of bachelor’s level education (BSN, and BSN is not even required to be a nurse). If a serviceable physician can be educated in 9 months what is all the additional time for? Somebody is lying or in denial. I work with doctoral level psychologists and if I told them I was just as qualified to do their work as a bachelor’s level technician they’d not take kindly to it either. And I would be wrong.

    • Pamela Wible MD says:

      It has more to do with who is best for the task at hand. And doctors who do trauma surgery need more years of training than say a family doctor. And a family doc in a rural area doing C-sections needs more training than a family doc in an urban area with lots of medical resources. I personally believe that docs would do just fine on much less training (I had 4 yeas med school + 3 years of residency). Makes no sense for docs who will be spending their time doing outpatient medicine to get so much inpatient (hospital) training. The entire medical education system needs to be revamped.

  55. Monica says:

    Here are some ideas. One option in the Match is to aim low. When I applied for residency (albeit many years ago), I chose as #1 on my list an unassuming little merchant marine hospital that nobody else would have thought of, and I got in. The other option is to find out the specialty that has the least competition to get into (maybe pediatrics or psychiatry or family medicine?) and go for that specialty. In my era it was Internal Medicine, so that’s what I did. Later on, I did a second residency. How about the military? They have residencies–look into them. The price that you pay is that you then owe the military time (4years?) G-d knows that they need doctors!
    The other thing that our letter writer must realize, is that there is nothing wrong with her; there is a certain persona–tall-walking, strong-talking, clipped, terse and lantern-jawed–that is greatly prized, and if you do not have it, or are a bit of a whimsical oddball, you may be at a disadvantage compared to your more conventional peers. However, she should not despair!

  56. Rajesh Ramaswamy says:

    If a P.A. or N.P. can do the job for less pay then that is what they will do

  57. Paramjit Singh says:

    US is a country where it is all about money. When anybody talks about the patient care, the first thing that pops up in a physicians mind is- will this patient have the ability or insurance coverage to pay for my services? What will I get and will it be enough so that I can buy mansions, private jets etc. etc.The things here have come to such a rot that a physician who has undergone all training and experience, is even certified by ECFMG (for foreign medical graduates), is not eligible to be a Physician Assistant (PA). What? You know why. If this country willlet these physicians become PAs, how will all the PA schools make money and pay the political interest groups. So the conclusion is- don’t ever think of coming here to practice medicine. If you do come just plan to make lot of money and then buy your way to whatever you want. Money and only money rules everywhere, but in US it rules most.

  58. Nabil says:

    Your situation is rather unfortunate and is understandable but it requires an out of box operational modality. This means you need to obtain training outside the USA. That would entail either trying for the UK or Ireland, however UK is still the best of the two options owing to more seats.

    I will explain what you need to do. First you need to take the IELTS Academic Version if you need to but if your medical education was in English then you are exempt. After this one then you need to proceed onwards to PLAB 1. PLAB is Physicians Linguistics Assessment Boards. The content is similar to USMLE Step 2 CK and in fact you can use your Kaplan review course to study for it. The MCQ’s are available online and you can access various Q Banks. The cost for PLAB is in UK Pounds 230 pounds and about 840 for part 2 of PLAB. The exam of PLAB 1 is easier for those who have cleared USMLE step 2 CK. Now once PLAB 1 is done, you have to go for the OSCE of PLAB 2. This is like step 2 CS and is tailored or customized to the UK personal and professional environment. I would recommend courses like Swamy, Samson, etc.

    Upon completion of the PLAB as in the USA you will not be usually completing an internship then you have to go for Foundation Year 1. For this you have to be eligible to work in the UK through either spousal sponsorship, immigration or citizenship. So see your eligibility to work there and if you can get it. The FY1 year process requires you to have a certain IELTS score along with taking this exam that puts you in a matching process. Once you get through the exam of FY1 known as Clinical Assessment that is a higher level than the PLAB 2. There are commercial review courses by Swamy and Samson. Once you clear Clinical Assessment then you must proceed onwards for training in the UK for Foundation Year 1 and Foundation Year 2; these are like an internship and transition year. Best is family medicine as your training will be after that three years only to complete MRCGP- Membership of Royal College of General Practitioners of United Kingdom; so you enter GP training scheme which is family medicine residency equivalent. Upon finishing your MRCGP you will be able to return to the USA and pursue a fellowship in hospital medicine, emergency medicine. What may be permitted is institutional practice where you receive academic attending privelages afterwards and are allowed to undertake Maintenance Certification of Family Medicine at a later state

    https://www.theabfm.org/moc/reciprocityagreements.aspx

    You will have to verify if they will allow you to receive any sort of advanced credit by the American board for yourself as they may fast track you. The other thing is if you wish to after FY1 and FY2 do internal medicine training in UK known as core training, which is internal medicine residency equivalent, also you can do it for peds. So you enter Core Training 1 and Core Training 2. During those years for medicine you take MRCP Or Membership of Royal College of Physicians of UK. That will grant you one year of credit over those two years if you wish to reapply in the USA. I think a similar arrangement is there for pediatrics whereby you take MRCPCH or Membership of Royal College of Pediatrics and Child Health during two years of core pediatric training. You can reapply to the US match and then enter training on a faster tracking basis.

    Remember whoever said if you don’t match its like you died of cancer, that’s not true.

  59. Emma says:

    Why do some people fixate on the OPs assessment of people she personally knows to be inept over the stark and horrifying situation she and thousands of others like her are stuck in?
    Political correctness always trumps real issues. Can’t discuss your devastation without putting on kid gloves to shelter someone els’s ego. You try this try being $450k in debt, ten years in thankless unpaid research working for toxic and rigid morons, living with your retired parents because she he meager income you make from a minimum wage job barely pays the transportation to get to that job and then come speak of middle level workers feelings which are hurt!

  60. Tora says:

    If you don’t have an MA how do you have an MD?

  61. Monica Bey says:

    I’m surprised at the number of people who were so critical of the letter writer who obviously was extremely upset and frustrated. Very sad that people don’t have more compassion.

    There’s clearly a problem if graduates can’t get residencies because there aren’t enough slots. That seems to be the problem. You spend eight years in school and hundreds of thousands of dollars and then you’re denied the ability to go the last leg? Sounds like something is really wrong.

    • Joel Austin says:

      The risk is not at all presented to med students either. So thousands of kids take on hundreds of thousands of dollars worth of debt not understanding that they not only have to pass med school but also must be in a high percentile to continue there training. Nor is there any ability for your MD to count toward any other medical career. My wife has a BS with honors, a MD from a top school, speaks two languages fluently, and is literally no more qualified than you or I to flip burger. The system is broken!

  62. Manuel O says:

    This article hits close to home. My brother and I are both IMG’s with hopes of matching into residency programs whenever the stars align in our favor. I have done just about everything since graduating from med school 4 years ago, I have worked in a 32 degree cold room cutting pineapples and jicama’s and saying to myself, “It is well.” The hardest part of of the whole thing is trying to explain the system to family members who are confused and keep asking questions. I would admit I did struggle with step 1 and failed it once but passed it on second attempt with good marks. Being an unmatched IMG reminds me of the story of Job, how do you remain hopeful and faithful when surrounded by so much hopelessness? It’s glad to know I am not the only unicorn experiencing similar hardship. The practical side of me wants me to give up and go a different direction but I look at the pride and joy in my mom’s face when she talks about us, I tell myself I have to see this through. I applaud the write for sharing her experiences. Hang in there and remain steadfast to the course….

    • Joel Austin says:

      Manuel,

      My wife just failed to match again this year. She would make a wonderful doctor! The system is so broken and no body understands what is going on. Can you message me please? We all need to connect and work together to solve this. jaustin.biz (at) gmail (dot) com

  63. Bill says:

    There is one other way to get a License in The USA I’m a FMG and also a US citizen, I spent years applying to Residencies through ERAS with few interviews and only one after passing step 3 without a match I went to Puerto Rico, being a US territory you can Apply to 1st year training at both ACGME and State accredited programs here called Internados. Catch is you have to habla Español. You can be licensed after the 1st year and move on to more years of Residency or work as a GP. It’s possible I’m doing it and many have before me.

  64. Amos Huntley says:

    Hello Dr. Wible,
    I would hire you as a personal doctor since I don’t have a lot of money and the medical plan I have will end once my job ends this April 2018. I have a problem with my kidney and not sure yet if I’ll need surgery. Since I have 1 month left on my medical plan hopefully the urologist will at least be able to tell me what’s wrong and what needs done. If it requires surgery and my insurance expires by then I’m willing to take a chance and hire you as a personal doctor if you are willing and understand I don’t have a lot of money. I guess this will have to be on the down low since you say you don’t have your medical license yet. PM me @ amosphuntley@gmail.com

  65. Hello! Everyone has to start with something, being a waitress is not bad. Doctors have to earn a living when they are students. It is difficult to study and to work at the same time. When you have to compose an medical fellowship cv and you do not have enough time to compose it on your own. This kind of utility will help you to deal with this daunting task and you will not have to waste your time on it. So, it is great that there is always a solution for you. You do not have to think about it over and over.

  66. Joel Austin says:

    Pamela,

    Is there a group of others like us?! I have only found you and perhaps one or two others. Did you match this year? Where are you now? We all need to connect! My wife was not allowed to finish her 1st year of residency (2015) after severe depression (onset by death of loved one). We have failed to match back into a spot each year since! She has passed all her USMLE steps and went to a top tier US med school.

  67. Dr. Francisco Antunez, Foreign Medical Graduate. says:

    Feel sorry for US graduate doctors. Education is not planned.

    I am a foreign medical graduate from Mexico, but I have not been able to pass my USMLE. I have the education to be a doctor, but the system rather have nurse practitioners working as doctors. There a huge need for doctors, but the government don’t see that.

    What can I say, if you are US doctors and unable to get residencies or be able to practice, it is the government fault. I am in a worse situation. Many foreign graduate doctors from Mexico and other countries /hadhave to work, for years as roofers, construction, you name it. It is a waste of time, money y effort. This country can benefit from many foreign doctors as well as US graduates, but yet they rather have an LPN, RN, BSN, etc., working as doctors; that is why you can see many iatrogenies. Well, citizens have what the government wants them to have and we don’t say anything.

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