A travesty: 4000 residency slots go to non USA citizens

[PreMed2006]

Everybody says there is physician shortage in America and the main reason is that the residency slots are limited. Yet, we are letting in 4000 non USA citizens and give up those precious residency slots. In the meantime, we gleefully reject 1000s of highly qualified Americans and take pride in it. Why can’t we increase the number of seats in American medical schools and accept more applicants specifically those 20% we reject with 3.8+ and 517+.

Just baffling

Prevalence of US-trained International Medical Graduates (IMG) physicians awaiting permanent residency: a quantitative analysis - PMC

International Medical Graduates (IMGs) contribute to about 23% of the physician workforce in the USA. Certain US-trained IMGs face long wait times for transitioning to a permanent resident status, which limits their ability to work to fullest ...

pmc.ncbi.nlm.nih.gov

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[X0001234]

I'm under the impression that we actually are increasing seats in American medical schools: Belmont(?) and Alice Walton will both matriculate their inaugural classes in 2025, and there might be other schools I'm unaware of. Also, you mention the issue is residency caps--how would more US medical students solve that issue?

 

[wysdoc]

Everybody says there is physician shortage in America and the main reason is that the residency slots are limited. Yet, we are letting in 4000 non USA citizens and give up those precious residency slots. In the meantime, we gleefully reject 1000s of highly qualified Americans and take pride in it. Why can’t we increase the number of seats in American medical schools and accept more applicants specifically those 20% we reject with 3.8+ and 517+.

Just baffling

Prevalence of US-trained International Medical Graduates (IMG) physicians awaiting permanent residency: a quantitative analysis - PMC

International Medical Graduates (IMGs) contribute to about 23% of the physician workforce in the USA. Certain US-trained IMGs face long wait times for transitioning to a permanent resident status, which limits their ability to work to fullest ...

pmc.ncbi.nlm.nih.gov

There are more than enough residency spaces for all our American medical school graduates.
That’s why there are some left for International graduates. The number of non-US citizens enrolling in our US medical schools each year is only about 150, and they are highly qualified.
An “international medical graduate” might also be an American whose grades weren’t good enough to be admitted to US medical schools so they attended a Caribbean school.

 

[VA Hopeful Dr]

There are more than enough residency spaces for all our American medical school graduates.
That’s why there are some left for International graduates. The number of non-US citizens enrolling in our US medical schools each year is only about 150, and they are highly qualified.
An “international medical graduate” might also be an American whose grades weren’t good enough to be admitted to US medical schools so they attended a Caribbean school.

If I'm reading the match data for this year correctly, that may not be true.

In the 2024 Match there were 38.5k Pgy-1 spots. 29.5k US MD Seniors applied for spots as did 12k DO Seniors.

 

[AJS59]

My understanding at least is not so much that there is a doctor shortage but rather it is a doctor shortage in certain areas. There's no shortage of people wanting to practice high end dermatology or other high end fields at large east and west coast academic hospitals; it is much, much harder to find American doctors willing to practice rural family medicine in Mississippi or Nebraska.

 

[stew_md]

Everybody says there is physician shortage in America and the main reason is that the residency slots are limited. Yet, we are letting in 4000 non USA citizens and give up those precious residency slots. In the meantime, we gleefully reject 1000s of highly qualified Americans and take pride in it. Why can’t we increase the number of seats in American medical schools and accept more applicants specifically those 20% we reject with 3.8+ and 517+.

Just baffling

Prevalence of US-trained International Medical Graduates (IMG) physicians awaiting permanent residency: a quantitative analysis - PMC

International Medical Graduates (IMGs) contribute to about 23% of the physician workforce in the USA. Certain US-trained IMGs face long wait times for transitioning to a permanent resident status, which limits their ability to work to fullest ...

pmc.ncbi.nlm.nih.gov

I'm going to play devil's advocate and argue that of those USMD and USDO seniors who go unmatched, it could be because they ARE unqualified, or chose to apply to a specialty that they were not competitive for. Unfortunately, there are going to be some medical students who are not competitive applicants to ANY residency program, this could be for a variety of reasons (bad interpersonal skills, failed attempts at STEP exams, poor academic history during medical school).

Additionally, there are some applicants who decided to apply to something competitive but did so with poor strategy (ie. deciding to apply to neurosurgery with low publications, no research year, bad away rotation performance, bad step 2 score, no back up specialty, and a poor demonstrated interest in the specialty).

I'm more inclined to believe that the latter category is smaller in size than the former, I think most US medical students get good mentorship and are smart enough to make an informed decision about specialty choice that is in their best interest.

In any case, the applicants that go unmatched likely have some combination of factors between these two categories, or poor mentorship that make them less than ideal-candidates.

There are many IMGs who are dying to come to America for a good quality of life and are willing to meet a far higher standard in order to do so. They have good step scores, well-written applications, and go above and beyond to earn those seats. Additionally, most of these 4000 IMGs you mention are filling spots of less competitive/desirable specialties like family med, internal medicine, emergency medicine, etc. that are desperately needed in America.

I think there is a balance between prioritizing American medical students and meeting our country's healthcare needs. I don't see matching 4000 IMGs as a bad thing at this time. Those medical students who went unmatched either need to seriously evaluate where their strategy went wrong when applying or consider a different specialty if they need to.

Also I believe the correct numbers are 20K USMD seniors and about 8K USDO seniors APPLIED to the match. There are more than enough spots to accommodate US students. I think this furthers the narrative that a lack of strategy and merit might be where these US students are failing.

NRMP® Celebrates Match Day for the 2024 Main Residency Match®

The NRMP releases results for over 44,000 applicants and almost 6,400 residency programs Today, the National Resident Matching Program® (NRMP) is excited to recognize Match Day for its 2024 Main…

www.nrmp.org

Match 2024: By The Numbers - NBOME

The NBOME applauds the extraordinary success of DO seniors who achieved a 92.3% match rate – the highest NRMP match rate on record.

www.nbome.org

Edit: I also love this video below, shoutout to the sheriff.

 

[Goro]

There is a surplus of residency slots.

IMGs take them because US MD and DO grads don't want to take them.

A number of those slots are also in toxic residencies, where the PDs are are only too happy to get near slave labor.

Lastly, there is not a doctor shortage, but a maldistribution. This may come as a shock, but many doctors do not wish to practice in, say, Jonesboro, AR or Lusk, WY.

 

[Mr.Smile12]

I already shared

Policy - "The Only Doctor" documentary (Al Jazeera English on YouTube)

This documentary is available on YouTube as of December 10, 2024. Dr Karen Kinsell is the only doctor in Clay County, one of the poorest and unhealthiest regions in the US state of Georgia. Her run-down clinic has served the rural community for 22 years, but faces bankruptcy. She takes no...

forums.studentdoctor.net

 

[Med Ed]

Everybody says there is physician shortage in America and the main reason is that the residency slots are limited. Yet, we are letting in 4000 non USA citizens and give up those precious residency slots. In the meantime, we gleefully reject 1000s of highly qualified Americans and take pride in it. Why can’t we increase the number of seats in American medical schools and accept more applicants specifically those 20% we reject with 3.8+ and 517+.

Just baffling

Gleefully? And with pride? Really?

The current clinical education infrastructure in this country cannot even handle the existing medical schools, which have proliferated rapidly in the past 25 years. There simply aren't enough teaching hospitals and practicing physicians who are interested in teaching medical students. This will not be remedied in our lifetimes.

As it stands, the residency selection process is biased toward US MD and DO students. They get first crack and IMGs/FMGs take most of the remainder. Having 40K US grads competing for 40K residency slots would have a litany of unpleasant consequences.

The system is also a brain drain that benefits the US by siphoning off some of the best and brightest from other countries. And the way things are going, many parts of the US that are most associated with nativist tendencies will become increasingly dependent on foreign-trained doctors. Irony is not dead.

Finally, if you have a 3.8+ GPA, a 517+ MCAT, and you don't get into medical school, there's a reason.

 

[osprey099]

There are not enough residency spots in certain fields but a surplus in others.

 

[LizzyM]

There are not enough residency spots in certain fields but a surplus in others.

Please expand on that idea. The size of a residency is dependent, in large part, on the number of patients/cases at the facility. One cannot expand a residency program unless there will be sufficient faculty to supervise and train the residents and sufficient cases such that each resident gets sufficient experience performing the procedures they are expected to learn.

 

[osprey099]

Please expand on that idea. The size of a residency is dependent, in large part, on the number of patients/cases at the facility. One cannot expand a residency program unless there will be sufficient faculty to supervise and train the residents and sufficient cases such that each resident gets sufficient experience performing the procedures they are expected to learn.

There are certain fields like dermatology where the number of residency spots are capped on purpose. There are other fields like rad onc and EM (nowadays) where anyone with a pulse can match. This is even more apparent in fellowship. For IM fellowships like nephrology, ID, geriatrics, pall care, even some of the "top" programs are actively recruiting and trying to fill their spots. Then you have competitive fellowships like cards, GI, heme/onc where people are re-applying multiple times just to get a crack into them.

 

[LizzyM]

There are certain fields like dermatology where the number of residency spots are capped on purpose. There are other fields like rad onc and EM (nowadays) where anyone with a pulse can match. This is even more apparent in fellowship. For IM fellowships like nephrology, ID, geriatrics, pall care, even some of the "top" programs are actively recruiting and trying to fill their spots. Then you have competitive fellowships like cards, GI, heme/onc where people are re-applying multiple times just to get a crack into them.

You are focusing on the desirability of various specialties and expecting the number of slots to closely mirror the number of candidates for that specialty (something of a market model) whereas the number of slots is dictated by the availability of physician-instructors and patients in need of specific services during residency training, and the needs of the population for providers in a specific specialty.

 

[eigen]

There are certain fields like dermatology where the number of residency spots are capped on purpose. There are other fields like rad onc and EM (nowadays) where anyone with a pulse can match. This is even more apparent in fellowship. For IM fellowships like nephrology, ID, geriatrics, pall care, even some of the "top" programs are actively recruiting and trying to fill their spots. Then you have competitive fellowships like cards, GI, heme/onc where people are re-applying multiple times just to get a crack into them.

If we follow this logic, it kinda sounds like Med Schools should start screening applicants to make sure that they're taking in people who will fill the spots where we need practitioners, by your logic. It's somewhat concerning to me that out of the thousands of medical students who want to go to medical school to "help" people aren't willing to go into things like emergency medicine and geriatric care where, per your post, physicians are very much needed.

More seat in residencies where there aren't sufficient patients when there are gaping holes in available family medicine physicians across the US doesn't seem to be a great idea.

 

[Crayola227]

I'm going to play devil's advocate and argue that of those USMD and USDO seniors who go unmatched, it could be because they ARE unqualified, or chose to apply to a specialty that they were not competitive for. Unfortunately, there are going to be some medical students who are not competitive applicants to ANY residency program, this could be for a variety of reasons (bad interpersonal skills, failed attempts at STEP exams, poor academic history during medical school).

Additionally, there are some applicants who decided to apply to something competitive but did so with poor strategy (ie. deciding to apply to neurosurgery with low publications, no research year, bad away rotation performance, bad step 2 score, no back up specialty, and a poor demonstrated interest in the specialty).

I'm more inclined to believe that the latter category is smaller in size than the former, I think most US medical students get good mentorship and are smart enough to make an informed decision about specialty choice that is in their best interest.

In any case, the applicants that go unmatched likely have some combination of factors between these two categories, or poor mentorship that make them less than ideal-candidates.

There are many IMGs who are dying to come to America for a good quality of life and are willing to meet a far higher standard in order to do so. They have good step scores, well-written applications, and go above and beyond to earn those seats. Additionally, most of these 4000 IMGs you mention are filling spots of less competitive/desirable specialties like family med, internal medicine, emergency medicine, etc. that are desperately needed in America.

I think there is a balance between prioritizing American medical students and meeting our country's healthcare needs. I don't see matching 4000 IMGs as a bad thing at this time. Those medical students who went unmatched either need to seriously evaluate where their strategy went wrong when applying or consider a different specialty if they need to.

Also I believe the correct numbers are 20K USMD seniors and about 8K USDO seniors APPLIED to the match. There are more than enough spots to accommodate US students. I think this furthers the narrative that a lack of strategy and merit might be where these US students are failing.

NRMP® Celebrates Match Day for the 2024 Main Residency Match®

The NRMP releases results for over 44,000 applicants and almost 6,400 residency programs Today, the National Resident Matching Program® (NRMP) is excited to recognize Match Day for its 2024 Main…

www.nrmp.org

Match 2024: By The Numbers - NBOME

The NBOME applauds the extraordinary success of DO seniors who achieved a 92.3% match rate – the highest NRMP match rate on record.

www.nbome.org

Edit: I also love this video below, shoutout to the sheriff.

Did EM stop being a competitive specialty?

 

[Crayola227]

There are certain fields like dermatology where the number of residency spots are capped on purpose. There are other fields like rad onc and EM (nowadays) where anyone with a pulse can match. This is even more apparent in fellowship. For IM fellowships like nephrology, ID, geriatrics, pall care, even some of the "top" programs are actively recruiting and trying to fill their spots. Then you have competitive fellowships like cards, GI, heme/onc where people are re-applying multiple times just to get a crack into them.

Rad onc too?

Man I'm out of touch with residency application

 

[osprey099]

If we follow this logic, it kinda sounds like Med Schools should start screening applicants to make sure that they're taking in people who will fill the spots where we need practitioners, by your logic. It's somewhat concerning to me that out of the thousands of medical students who want to go to medical school to "help" people aren't willing to go into things like emergency medicine and geriatric care where, per your post, physicians are very much needed.

More seat in residencies where there aren't sufficient patients when there are gaping holes in available family medicine physicians across the US doesn't seem to be a great idea.

Med schools have been trying to do this back when I was applying more than a decade ago. Everyone, including me, would say stuff like "this is why I wanna become a pediatrician" on their essays and interviews but advertently or inadvertently end up doing something else (I am heme/onc now).

The way I see how the system can be fixed is through targeted programs addressing the critically deficient specialties like peds and FM. The government is already doing this with programs helping out with loan forgiveness/etc but it's not enough. I think if government does something where PSLF can be just 5 years for those doing "deficient" specialties like FM/peds whereas 15 years for those doing "saturated" specialties like ortho/derm, that may be a worthwhile endeavor.

 

[osprey099]

Rad onc too?

Man I'm out of touch with residency application

EM because increasing encroachment of mid-levels. Hospital admin recognize its more economical to hire 1 EM doc supervising 5 NP/PAs vs hiring 5 EM docs.

Rad onc was once very competitive, but then became super saturated. You can still make >500k but you have to work in pretty undesirable or rural locations.

 

[osprey099]

You are focusing on the desirability of various specialties and expecting the number of slots to closely mirror the number of candidates for that specialty (something of a market model) whereas the number of slots is dictated by the availability of physician-instructors and patients in need of specific services during residency training, and the needs of the population for providers in a specific specialty.

I agree with this but the original poster is asking why there is a shortage of physicians when we are accepting foreign docs and denying entry to US docs.

At the residency level, so many MS4's apply to competitive specialties and don't get in. Could these US MS4's match into residencies like peds, EM, FM? I have no doubt they can. But they are choosing to shoot their shot at more competitive residencies and as a result, the less desirable residencies cannot fill their spots and have to resort to taking FMGs/IMGs/etc.