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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200 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.

        • Jaquon says:

          You’re an idiot. Cry me a river. I’m so sick of the white privelage argument. You realize there’s more women than men in medicine right? I am surrounded by women drs nurses and low level staff all day (cna, lpn) all are women and half are black … I’m black too you dumbass

        • Timothy Leeny says:

          Please keep studying English. You are getting there! Keep it up! 🙂

    • Hardcore Doc says:

      You might be that illiterate cousin she was talking about.

    • Gavriel says:

      She is in a situation that is frustrating beyond belief. She has put at least 8 years of her life into reaching a certain goal and has not acheived it. Not only that but she is even further away from that goal then others who have put a in fraction of her effort . Everything is context her comments can be construed as dispariging if her goal was to put down others. She however is merely writing from a place of extreme sadness and frustration please have some compassion.

    • Melissa Garcia says:

      I thought the same exact thing!!

  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.

    • Mohsin Babar says:

      I read the story of this person not being able to find a residency and my heart shattered. I thought my wife was the only one stuck in this situation. She has 2 attempts, though she has passed steps 1,2 and 3 and still having hard time finding a match. She is doing an externship in Philly at the moment. Even though we live in Texas, she went the extra mile to go out there for a month and try to prove her work. She treats this career as a passion and everywhere she has worked they loved her dedication and hard work. But when it’s actually time for her to get what she deserves, the doors are closed on her. She is an American graduate, with around $200,000 in debt and the funny thing is the school which she graduated from gave her two interviews and still didn’t take her. The place who suck the blood out of you didn’t have a spot for you. One more thing, she is doing an externship as we speak and now the program director who she is working under asked her to work another month under her assistant program director. Even though she consistently says how good and dedicated my wife’s work is. Can someone explain to them that we have a family too. She is away from her family for a month and showed you “THE PROGRAM DIRECTOR” her work and you still want her to come back and work with your assistant, just because you all can do that to her. I mean she works at a community clinic right under the attending. Been doing it for 2 years, they have given her more responsibilities for mere $15 an hour. MA’s come and ask her for help and she ends up doing all the labs to calling insurances to sending paperwork to physicals to I don’t know what else, since the list is long. But she can’t prescribe even when an MA comes to ask her if this the right medicine to prescribe? Everyone I talk to tells me she needs connections and networking, like wow I didn’t think I was in South East Asia or something. She had attempts but we had two beautiful kids at the time and I know it’s not an excuse, but my thing is she came back and passed them and passed her step 3 in the first attempt. Doesn’t that show dedication? Doesn’t that show no matter who tough it gets she will get it done? Why can’t they see it like this? By the way you mentioned contacts in New York, I m willing to take them. Just FYI we drove to new York from Texas and went to many programs to c if they will accept her resume and at least talk to her, but the assistants who are NOT even MD or even close to it decided otherwise and didn’t giver her a single chance to speak to a program director. How much more dedication are they looking for? Try driving for 30 plus hours with 2 kids in the back seat. All I know is she is a great individual and will prove to be one of the best in her field, when given the opportunity. Good luck to everyone in her position and hopefully this plead of mine gets to decision makers and may by the grace of God they realize, how depressing is it to see a loved one in distressed and pain day after day for 4 years and counting.

  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.

      • Ismael Landron says:

        I am a physiatrist, MD without a license now 4 years and I just can not seem to find any real option to get back into my career or my calling.
        Any advise will be appreciated.

      • Doctorinwaiting says:

        Hello Dr. John

        I know this post is a few years old but still hope you can be of help. What would be the best way for me to reach you. Any guidance or advise you can provide would be greatly appreciated.

      • Arsh says:

        Hi Dr. John,
        I am another one amongst many of MD’s without a license. Would it be possible to connect with you?

  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.

    • Rick Lipary says:

      You are totally right! I won’t get into demographics, but without DOUBT, cultural assassins and man hating Bolsheviks are teaching this sick garbage to a young, impressionable, and often backward and not very intelligent base!I guess if they can STUPIDLY believe that white males are large and in charge, they will have a built in excuse to keep using and abusing us!

  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?

    • Pamela Wible MD says:

      Medical Assistant. Yes, she should be able to get her MA license. Still the entire thing is maddening

    • John P says:


      The letter writer’s medical education would not prepare her for licensure as a medical assistant (MA). She would need to go to a vocational school to do this. Her MD is completely irrelevant to MA training.

  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:


      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.

    • Erin says:

      I compliment you. So many nurses like you have kept me from my wit’s end and even suicidal nights due to the discompassionate unemathatic nature of many doctors, green and not. I see what you see.

  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 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.

    • Rick Lipary says:

      You are totally right! I won’t get into demographics, but without DOUBT, cultural assassins and man hating Bolsheviks are teaching this sick garbage to a young, impressionable, and often backward and not very intelligent base!I guess if they can STUPIDLY believe that white males are large and in charge, they will have a built in excuse to keep using and abusing us!

  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. 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.

  28. A PA perspective says:

    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?


    • 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

  29. Anita Fullbright, FNP says:

    I hope she’s looking at research options.

  30. 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.

  31. Cornel says:

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

  32. 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.

  33. 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!

  34. 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.

  35. 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.

  36. 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.

  37. 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.

  38. 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?

  39. 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…

  40. 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?

  41. 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!!

  42. Bill says:

    Which medical school. And where?

  43. 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.

      • Elspeth says:

        Thoughtful comment. My father was a ward orderly before medical school. I’m a nurse. Working as CNA or in some capacity in patient care can be useful & possibly predictive of whether the field is right for you, as well as added benefit of humility. I’ve known doctors staff worked with collaboratively. & doctors staff worked “for.” The former is immensely preferable & a lot more fun!

  44. 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.

  45. 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.

  46. 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.

  47. 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.

  48. 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.

  49. 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

  50. 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.”

  51. 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.

  52. 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.

  53. 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.

  54. 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!

  55. Rajesh Ramaswamy says:

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

  56. 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.

  57. 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

    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.

  58. 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!

  59. Tora says:

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

    • Pamela Wible MD says:

      I don’t have an MA and I’m an MD. Not a prerequisite.

      • Doug says:

        Pam-We went to med school together. I ended up not entering the match . I have had an interesting career in healthcare in a variety of roles: consulting, Wall Street sales, pharma biz dev and pharma marketing. There is a way to forge a career for MDs who are not a good match for medicine (while I had the smarts, I didn’t have the passion). We were lucky to go to a relatively less expensive state medical program. My heart breaks when I hear about the levels of debt these new docs have.

        • Pamela Wible MD says:

          Doug Sobelman! I think I got your name right 🙂 Great to hear from you. We were so lucky to have cheap tuition at UTMB and you make some excellent points. The debtload now is out of control. Are you retired now?

  60. 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!

  61. 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:


      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

    • Elida Boston says:

      I can relate to your story, Manuel. So much talent wasted when our country needs health care workers, healers. There are so many places where physicians could help and volunteer: Aid to Women, Mercy Care, St. Vincent de Paul…These IMG (I know a couple of them) are professionals who have a comprehensive understanding and knowledge of medicine, and they are wasted. Many fail the USMLE because the medical schools where they studied DO NOT TEACH THE EXAM. By this I mean: they go to medical school abroad, and the school is not organized to have the student pass the USMLE. Some of these IMG have years of clinical practice, a residency, fellowships… It is sad, we could as Americans, find a useful path for these IMGs, to serve our country. What a waste, so sad! We can do better.

  62. 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.

    • Joel Austin says:

      Bill can my wife and I contact you? We are in the same boat.

    • Elai says:

      Hi Bill,

      I did have my USMLE STEP 3. Please share me list of programs offer the one year residency. Are these ACGME accredited?
      Can I get a mainland license from Texas after one year ?
      Is this paid intern position?
      When is the application starts?

      I appreciate your update.

  63. 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.

  64. medical fellowship cv says:

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  65. Joel Austin says:


    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.

  66. 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.

    • Elida says:

      I can totally relate to you. I understand the situation you describe. These IMGs cannot even be in patient education!! I know some who work as medical interpreters… Of course, it is not only IMGs; there’s also those who have a PhD in physics and a biologist!

  67. Jack says:

    I was let go from my residency program years ago for substance abuse (pain) following a neck injury. I was in bad shape and should have taken a few months off. However I tried to tough through it and I failed. There is not a day that passes where I don’t wish I handled things differently. I was told that if I went through remediation, consisting of counseling and drug tests, I would eventually get back into medicine. It’s been 6 years with perfect compliance, but I was not able to secure another residency. Have all my steps passed, good scores, return to work evals, about a dozen LORs including from my previous PD, but no luck.

    I know exactly how the OP feels, and those of you whom are beating on her for “offensive” choice of words need to back off and cut her some slack. And stop using this term “red flag”. She is not a red flag and neither is anyone. She is stuck in a system that was designed to work only when things function perfectly. There are no provisions for outliers. Those of us unlucky enough to find ourselves in a group outside of the ~90% success rate are left in a desert with no canteen or compass.

  68. Debora Messier Briggs says:

    Thank You for this article, however I will say that I have a similar dilemma. This injustice is not just occurring in your field. I have been an LPN for 37 years. I am in Masters program at present and have had all of my sciences etc for a BSN level RN. My experience ranges from a level 1 Trauma center in med surg to working in critical care back in the 80s. I worked in home care several years after tenure in many hospitals and was a school nurse. I was an administrator for 12 yrs and also did case management for several years. I have done evidenced based research and also quality interventions in managed care. Today I am being forced to take a year off from work and go back into clinical to prove I am worthy to sit for RN boards after 37 years in my field and finishing a Masters in Health Administration program with a 4.0. I hardly read the books because I learned this already in the field. We have a great need for providers in every area and I will say that there is a huge problem in the licensing and educational realm for medical providers. Very frustrating… Now I am being excluded from roles all because I gained expertise from crystallized intelligence. I would be happy to just test the NCLEX to prove I am skilled to perform at what they deem as professional level…This system needs reform.

  69. Natasha says:

    If the people who don’t match after years of going through med school…don’t deserve residency…that’s fine.

    But can we please have some way to find a career without starting from scratch in another field?

    Can you imgaine paying a 300,000 dollor debt while being qualified to earn only minimum wage?

    The utter depression a human might sink into because they might realize…wait I’m 30 with a 300,000 debt. I have no money to build my future because any thing I earn goes to my debt?

    Wait I’m 30. Can I afford to have a child unless I become a physician? Can I go somewhere else and be valued enough without needing to go through another program (losing more years of earning potential and then and not even making enough to start becimu g financially stable)?

    Maybe while a person is in med school they got married, had a child, or a parent got I’ll. Imagine showing up at the doorstep of really desperately needing to be a financially stable adult…and you realize u can’t get through and ur degree isn’t valued enough to gain stability.

    Maybe what we need. Is not to have these students so much in debt that being denied the ability to practice medicine…doesn’t mean their life stops?

    An MD is the only degree that costs so much. And is valued so little on its own.
    If we could walk away with some debt forgiveness … I’m sure we wouldn’t piss everyone off who is judging us so harshly.

    How do you pay off 300k, and still start your life if the best youre able to make in other fields is like 60k?

    • Erin says:

      Some people should just be happy. Be happy that they’re able. Able to work. Able to have kids. Able to get married. Able to drive. Able to go to the bathroom. Able to be able to have debt. They’re are Americans who can’t do any of those things. Americans who also have years of education who have to constantly educate their “far superior” doctor people. People don’t automatically deserve respect for becoming a doctor just like you don’t automatically get more sympathy because your a doctor with real life problems. You get respect because you actually work for it. And doctors who deserve it go above and beyond what they pay for.

  70. GK says:

    My husband is an MD who graduated from a well-respected private university and did not match into residency. He is currently working in a job that requires no college degree. So like others in this thread, we have over $300k debt and no correspondingly high income to pay it off. And if he didn’t match the first time, the way things are looking, his odds of matching aren’t going to be better later, no matter what he does.

    I fully agree that our medical education system is broken. But here’s what gets me: My husband went through four years of medical school with no advisor. When he struggled academically, no one seemed to notice or care. No one said, “Let’s make a plan to help you succeed.” Or even, “Maybe you should reconsider a career in medicine. If you don’t have the grades to match into residency, maybe you should cut your losses and get out now.” What kind of program doesn’t have advisors for its students??

    I am an “advanced practice provider” who has completed a collection of undergraduate and graduate-level health-related degrees over the years. In every single program,I had an attentive advisor. If I forgot to check in with them regularly, they hunted me down. Even PhD candidates have advisors. Why, oh why, do not medical students? While my husband was in school, a student a year after him committed suicide. I couldn’t help but wonder if she was another struggling, forgotten soul whom no one seemed to notice.

    While we cannot fix our broken medical education system on the national level overnight, certainly individual schools could use some of the $60,000 a year we pay them to advise and mentor their students appropriately. But then again, if they lost a student or two who decided to cut their losses and leave school, the school might lose some tuition money and worsen their graduation statistics…heaven forbid.

    • Rick Lipary says:

      What your husband has experienced is what almost ALL men in all fields regularly face and suffer while matriculating! Women just don’t admit it, because it would mean a moral obligation to change, and would interfere with their lame, sexist, and false women’s rights arguments!I suffered the same fate when I was studying Constitutional Law at California State University, Long Beach in 1980. I am a disabled Vietnam combat veteran, but they only offered the course I needed on Mondays, Wednesdays, and Fridays at 10AM, which interfered with my medical problems and treatments. Do you think the male professor cared? Hell, no! He was knee deep in young, cute, and affluent young women ingratiating themselves with him! Conversely, I was a disabled combat veteran and almost penniless, but still forced to beg for even SCRAPS of help and tutoring. There are SOOO few mentors for even deserving male students (the attitude has ALWAYS been, “You are MALE. Do it YOURSELF!”) and so many mentors available to affluent and undeserving female students! They don’t even have to undergo a needs test! That was the only course I ever failed. I took it later with a better professor (although still destitute and suffering from war disabilities) and passed. I wound up in business for myself, and did well enough to retire at 51!

  71. Timothy says:

    I believe you are the dumbass for replying like that. Have some damn respect for other people.And by the way, I’m black too.

  72. CJ says:

    I find it VERY hard to believe that someone who graduated from a licensed USGME US medical school who passed USMLE’s could not find a US residency program in some field. Even the person who graduated last in my class with worst passing USMLE scores got a residency in US. It wasn’t their first or second choice but they are practicing MD’s today. IMO there must be something fundamentally wrong with the candidate. i.e. failed USMLE multiple times, personality disorder etc…

    US residency slots are funded by CMS and US grads should get preference.

  73. Shaleba says:

    People who dont understand what it is like to be in this position always want to attack the person who is crying out about how illogical it is that people with less education and training are given more authority. It is profoundly disturbing. I am also traumatized by what the med board did to me in this regard especially bc I was a nurse and I went to med school instead of NP school. The med board denied ME a basic license claiming of all things, knowledge defecit.(I graduated 5th in my class, by the wsy). So when I scream out to the world that an NP can diagnose and treat patients but I cannot and how stupid that is…some people act like they need to defend NPs. I actually had to explain to them that I have nothing against NPs. My anger is not directed at them, that would be completely irrational. My anger is at the regulatory institutions who fail to recognize this stupidity and waste of education, not to mention the extensive harm caused.

  74. Dolly Zachariah says:


  75. Daniel C. Ashley says:

    An MD with a JD makes more money than God.

  76. RGg says:

    Very true as I am in the same boat! Its very painful…….

  77. Erin says:

    It seems as though we’re going to be getting 30,750 new doctors a year from your numbers if they are able to complete their residencies. Considering how I’ve seen the healthcare industry change for the worse over the past four decades. I’ve been a chronically ill patient since the mid 1980’s, since I was just a little girl, going to see a doctor at least once a month ever since. I’m not sure if it’s schools teaching a new school of practice, the change in generations, lack of a free market with doctors’ overt threats of the use of blacklisting patients who demand better care, but I can say with certainty that most doctors today are not what they used to be and most ,definitely, don’t forget what they used to do for patients. What one doctor would normally treat me for fifteen years ago, now I must see three more. They used to care about how far and how often I’d have to come to see them because that meant more stress, more pain, more cost, which could mean more disability, which is what they ultimately were trying to prevent. Now, the more visits the better and if it’s the tiniest bit out of their perview, they don’t bother to educate themselves and practice medicine on me. No. Just send me off off to see someone else and sometimes I have to find the referral. I’ll give you a real life example of something one of my better doctors does that is a pain, doesn’t really make sense on my,vthe patients part, and didn’t happen this way a decade a go. I went in and saw my rheumatologist for my six week follow up. Something I’ve been doing for thirty-five years. I tell her that I need new resting splints for when I sleep at night. The old ones’ my former rheumatologist ordered for me no longer fit. She tells me that because they don’t have an occupational therapist at their hospital, only a physical therapist, that I should just probably go to a surgeon. They could probably have them made at their clinic because they have occupational therapists on staff. My former rheumatologist ordered them, found an occupational therapist in my town that took my insurance, and set the appointment up for me. And, voila, I went in to that appointment and had them made. Simple. That’s what a doctor should do. Make things as simple for the people who are in their care as possible. Why? Because we’re sick and everything but being sick is already harder than it ought to be. Now his isn’t just one time something like this happens. It’s all the time. I have two doctors and one surgeon who still practice medicine like it used to be practiced. Most doctors have seemed to forgotten that it’s even a medical practice, remembering what the practice even means. It literally means that if you’re a doctor that you’re able to practice medicine. It’s not a pure science. One+one does not always equal two when it comes to individual medicine. So, with very few physicians having the empathy, time, or professionalism, that once was the gold standard amongst healthcare professionals, I see no problem with less doctors doing less and being more concerned with CYA. Until we change how they operate in general, why should we make more money available for more of them to be available to us? Just a side note. My boyfriend is a LVN in Texas, they’re called LVN’s in Texas for your information, and he knows more than half of my doctors. I don’t know what’s up with your cousin, buy if she’s as bad as she sounds and you have any integrity then I would think you would be worried about her patients. In that case, I would think that you would report her and being as your a MD I would think you would have a duty to. Their’s a whole oath involved and everything. Maybe you’re not in it for the whole caring for patients idea. In that case, maybe you shouldn’t be in it at all.

  78. Dr D says:

    This is a truly relevant thread! I can understand the anguish this individual feel. To be that educated and yet be seemingly reduced to almost nothing. I believe a lot of people cannot understand the mental scarring this experience can put on an individual. You really have to experience this to truly understand the many feelings associated with it – SHAME, disappointment, frustration, anger, DEPRESSION (just to name a few). Her words may seem a bit harsh to some, but context is important. This is written in moments of deepest despair and frustration. Trust me – I’ve been there and often find myself there at times. I thank her for sharing what so many others feel but keep inside. I can definitely relate!

    I am an IMG who at the time of graduation from medical school was not a US resident. I did the USMLE exams and thankfully I passed part 1 and 2 as well as CS on my first attempts. I stumbled on part 3 but passed on my 2nd attempt. I recently became a resident and applied to the match but with not even an interview. My field and passion is pathology. Prior to migrating to the US, I was in a residency but had to leave (for migration purposes). During my time in residency I did a bit of research and those papers should be coming out soon. I even did the part 1 fellowship exams for the Royal College of Pathologists in the UK and passed March of 2018 … I will attempt FRCPath part 2 April 2019. I’m hoping these help the next time I attempt to apply in the match.

    Although I keep aiming for the goal, I think you must always have a backup plan in case residency doesn’t happen (highly likely for me). I’ve only seen post here relating to clinical medicine. My field is paraclinical medicine. I have applied to a clinical laboratory scientist training program and thankfully was accepted. I start next month. It will be 1.5 years for me but at least by next December I should be able to have a job that pays more than the minimum wage.

    My reasons for writing here are that I truly understand the pain, mental anguish and scarring of not being able to match but also to put another possibility out there that might help someone else who is reading this. For me, I will complete this CLS course and get a job and try and see how I can work my way up … either by trying to match or by teaching in addition to working in a lab.

    For a country that has such a lack of physicians, the system really needs to change. It is BROKEN.

    I am also for a forum where MDs or DOs (or any other health related profession who are stumped) can communicated and offer some sort of support to each other. Suicide in physicians who match and have careers in medicine are high, I imagine the danger of suicide and suicidal thoughts in doctors who did not match to be a very real concern.

  79. Jose Delgado says:

    Let’s start with a simple: “life is not fair” yet there are always opportunities available if we are willing to look for them. I actually have General Practitioners, Nurse Practitioners and Physician Assistants working for me. I’m also looking for more General Practitioners to cover some of our clinics in Florida so the lack of having a primary care specialty or been board certified is not an issue. Yet I have seen the issue of not been able to get a match more times that I care about. I’m trying to work with some schools to see if we can come up with alternatives that will help these graduates do something with their lives. The key here is to be creative. Simple options I would recommend for those that didn’t match include but are not limited to:

    Look into the pharmaceutical industry for a job;
    Consider academics as an alternative;
    Research can always be an answer;
    Getting a law degree will set you apart;
    Compliance as a career with an MD degree can open new horizons;
    IT (software programming, cybersecurity, new devices, data processing);
    Of course, don’t put down the NP or PA track as an option;
    Last but not least, never give up.

  80. Nkg says:

    As a fourth year medical student who just failed to math, this article scares me to death. Wish the system was different!

  81. Sheila says:

    Hi fist off my respect and love for you. My brother graduated Med School top of his class. Now he’s never been a good tester. He was a victim of the USMLE policy of testing attempts. Now this kid tested with an I.Q of over 135 as a kid so he’s no dumb bunny. Just a different learner. So the last 10+ years this very capable, caring and empathetic man has been shunned by the medical community and has been bouncing from one high school type of job to the other. I feel is unfair we have all these physician from half across the globe with some sketchy credentials and our government preys on our in home medical students which usually graduate with a debt bigger than a typical mortgage. Maybe I’m ignorant but is heartbreaking that someone’s talent and intellect goes to waste due to our system not only charging them a ridiculous amount per attempt getting them further in debt to then not being able to at least offer an avenue to pursue their career of choice. I’m his older sister and it breaks my heart to no extent that I can’t do anything to help him.

  82. Rick says:

    Well, I knew you weren’t a WRITER!

  83. Credentialing Specialist says:

    Maybe there is a very good reason that the writer didn’t match. Maybe we are all better off without the writer practicing medicine. Just a thought.

  84. Marco A. says:

    I had at least 2 people with an MD apply for any kind of job available. I hire them, because the knowledge is there. In my office we have them work the Preventive care part of the clinic. They know the reasons why we do preventive care, They can read labs, they can explain the process to a patient.

    Managers need to be creative, and most MD’s will be glad to give a letter of competence to an MD so they can do the job of o an M.A.

  85. Sasha Parker says:

    I totally understand your frustration, the system is broken and most definitely should be fixed. However, before you proceed to a residency and ever get your license I hope you take the time to work with the clinicians from the various disciplines you have so rudely and with a wide swipe of your hand disparaged. As an RN of 25 years I have met and worked with highly educated LPNs and MAs who never cease to teach me something if I will only listen. “You will find that good nurses can teach a new physician how to be a great physician.” That is a quote from a friend of mine who has been a physician for 30+ years. 😉 To truly evaluate my patient I may ask questions of every person involved in a patient’s day, clinical and non-clinical- the CNA, housekeeper, dietary aide, maintenance man or even a receptionist who saw the patient rise from the chair when no one was watching, what they throw away that they don’t want seen, etc. Please learn not to discount anyone you work with, we are all part of the team. The physician isn’t the king of the mountain, he/she’s One part of the bedrock that stabilizes the whole house. Maybe that’s why you didn’t get into a residency yet, maybe they wanted You to get some experience working with your peers. Written with the utmost respect to the thousands and thousands of physicians who save lives and work miracles with rest of us every day. May your journey be blessed.

  86. Jay Peter Mathew says:

    Also, you guys need to realize there are Med Students who can’t pass their USMLE STEPS due to the hard style of questions. They have PhD doctors formulate these questions that doctors of today can’t even answer. These questions are ridiculously hard and no matter how much you study, you can’t pass. Many students cheat and find ways to pass these exams without studying. Most universities “buy” usmle questions and have their students study those specific questions. Unfair advantage on other students.
    USMLE is a Scandal. Cheating is widespread. USMLE is a billion dollar industry with corruption at the very top!!!!
    Sad that good doctors can’t pass exams and then get into residency. USA’s medical system is messed up.

  87. Samar Misra says:

    It is the worst injustice and unfairness of the system to not allow many dedicated, hardworking and sincere unmatched MD, DO, MBBS or equivalent degree holders to utilize their hard-earned degree. Many people in life truly put in their best and rigor, but unfortunately fall short due to brutal, unfair competition and clearly try their best with will and sincerity and do not make it through.

    Here is a heartbreaking, touching story that had to be shared of a lady who earned a MD at age 47 from a decent caribbean medical school, but could not match and had to pursue more school debt to become a Nurse Practitioner:

    Worst injustice needs to change in the system surely and even if there are many domestic and foreign medical graduates that went on to do residency and such, others who could not that have acheieved their hard-earned degree through perseverance deserve something too.

    Are there countries besides the USA, where medical doctors do not have to pursue residency?

  88. DocADC says:

    Hi I am an old IMG from India(36 years old).. I am pursuing my MSW degree now and my long-term goal is USMLE. I will start pursuing it from 2022. I don’t know if I will ever get into residency but I will keep pursuing it…..

  89. harold friedman says:

    The competition for resident training positions becomes more ferocious each year. The cost to the hospital of one resident position is approximately 100,000 dollars to include salary and benefits (mal practice, health care et). An advanced care provider (NP or PA )can cost somewhat more than that. The medical schools are not to blame for the shortage of physicians to care for patients in the US. The video associated with this post seems to put the blame on the federal government for not raising the cap on the number of physician resident programs they are willing to fund. This is true, but who is to blame for the average 200,000 in debt that each student is saddled with after completing medical school. If that person is unlucky enough to fall in love and marry a fellow student- they now have 400,000 in debt. Assuming a salary of around 75,000 as a resident each year for a period of 3-7 years (some surgery programs are that long), excluding additional fellowship for another year or two. How is someone supposed to then take care of patients and start a family, buy a house, raise children, retire a 200,000 debt on a salary of 100,000-150,000 (primary care provider). Now this is a person who spent 4 years in college, 4 years in medical school, and perhaps 3-7 years in additional training. So now we are not only talking about not enough training positions, but also a system that pushes future doctors into significant debt. There are so many things wrong with the health care system in the US- not enough doctors, patients who are unfunded or underfunded for their care. Insurance plans with huge deductibles. The leading cause of individual bankruptcy in our country is health care related. Once in the hospital nurses and doctors spend many hours each day taking care of the electronic medical record, rather than spending time with the patient. Have you been to an office visit recently, where your doctor is accompanied by a scribe who feeds the computer while the doctor talks to and examines you Or if his practice cannot afford a scribe then he types into a computer while chatting with you? I have truly enjoyed my many years of teaching medical school students and residents, interacting with my colleagues, and making my patients better. But there is a great deal that is broken with our current system, and we seem to lack the leadership within our craft to force change in the system that will benefit everyone. Hardly a day goes by when I don’t hear some horror story about an interaction between an insurance company and a patient. Patients get huge hospital bills because non profit hospitals, and those with residency training programs have to compensate for the unfunded and underfunded. patients pouring through their emergency room doors. So the hospitals merge with one another to create systems so they can better bargain with insurance companies and suppliers of their equipment. So you get appendicitis, if you then go to the ER, get admitted, operated on, and discharged the next day a hospital bill is generated for all the services supplied. This bill will inevitably be > 10,000 dollars. Now you fall into one of several categories. 1) Your have no insurance and you have to pay the full bill (perhaps the hospital will negotiate a reduced fee or payment over time if you have no resources. 2) You have insurance with a high deductible- you then may be responsible for 5,000 or more of the bill while the insurance carrier pays the rest. 3) You are rich, have medical insurance and a secondary policy which pays for most or all of the bill 4) You have medicare – you are now responsible for 20% of the bill 5) You have medicaid- the hospital accepts whatever they can from medicaid and write the rest of it off – as they may also do with those without insurance. 6) You are eligible for Obama Care – you fall into the same category as #2.

    Well, I have rambled long enough. The answer lies with physicians sitting down with intelligent lawmakers (who are willing to do the right thing), scrapping the current system, and redesigning from the ground up. I do not think this will happen in my life time. As for the person who did not match. He/she should do what most of those who really desperately want to enter a resident training program often do- get a research job for 1-2 years- publish a bunch of papers and reapply. If you received mediocre grades in medical school and performed poorly on step 1 of your national exam (which your inability to match might suggest), then publishing a few papers and reapplying in another year (when they are doing away with exam scores for step 1 – you will probably succeed. It all depends on how bad you want it.

  90. Marie says:

    Amazing Blog, loved the way you described it.

  91. omo says:

    if an lpn who schooled for 1yr can be licensed or an rn who spent two years in school can be making 80k a year because of licensure, we seriously need to change the way medical students are licensed or find a way to make use of them rather than leave them working as a waitress or lower than a nurse.
    We should be licensed and able to work post passing difficult step 1 or able to work in a nursing capability and make as much as a bsn nurse. Nurses go on to become NP and we get stuck even with passing some series of difficult exams – sucks.
    Like Nurses, we need to be getting that license from start with ability move up like the NP, from lpn to rn to msn to np -all getting good pay right from start, those nurses are smart in their thinking and protect their profession. additionally, they branch into every area of job out there, school nurse, clinical nurse, cdip-rn, etc.
    while some of us go back to nursing school, racking up more unnecessary loans, others have no choice than to wait on medicaid like someone who was never educated, waste of knowledge base/ waste of govt money, we could have been more self reliant and contributed to the society but instead, the situation what caused such reversed.
    Just to point out this,we shouldnt have to go back to school just to learn things we did with nurses and doctors during clerkship nor work in positions like we never studied anything, its truly a shame; things clearly need to change, the question is how?

    • Pamela Wible MD says:

      We need more targeted personalized educational tracks. We are instead trained to be interchangeable worker bees. Empowering healers to become self-actualized is the way to go.

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