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Skeptial Scalpel
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.
Skeptial Scalpel (click to view)
The following was submitted as a series of comments on my Physician’s Weekly post about Missouri’s new law allowing medical school graduates who did not match into residency positions to work under supervision. The comments have been edited for length and clarity:
I am a 38-year-old US medical graduate who has attempted to match 3 times with no success. I decided not to throw the money away again this cycle. I have half a million dollars in educational loans. I would exchange my situation with any non-US-IMG because they probably don’t have massive loans. I have seen kids coming fresh from India with no loans who match in their first attempts because they score high enough on USMLE to separate themselves from people like me.
Based on USMLE scores, the matching system is fair to a lot of us. What fails US grads is the educational loan structure that allows us to borrow without any accountability of medical schools that are benefiting most. If medical schools are going to produce doctors who cannot match after genuine attempts, the schools should be blamed. They have standards that require students to pass each course in order to graduate. If they believe a student is not good enough to become a doctor, they shouldn’t graduate the student. Students would benefit more if the medical schools could determine which med students won’t be good doctors earlier on and dismiss them. Then the students will not pile up so much debt.
Some graduates find that their training is not good enough to become a physician. It’s a scam. Why do medical schools get a free ride on this? Everyone who has completed medical school successfully with passing scores on USMLE Step 1 and 2 should be allowed to use that acquired knowledge. Why not let those who have demonstrated they can work under supervision get job?
What fails US grads is the educational loan structure that allows us to borrow without any accountability of medical schools that are benefiting most.
When I try to get a nonclinical job, they read my resume and tell me I am overqualified for the position. I have tried to hide my MD degree and use only my Bachelor of Science degree (biology) in order to get a job. But they tell me I don’t have experience, and the big gap between my undergrad education and my current situation cannot be explained. Some employers have asked me if I spent the time in jail.
I applied to PA schools last year and had no success. Some of my rejection letters said as a medical doctor, I am not a good fit for PA career. Some PA programs wanted me to go back to college again to take pre-med courses.
Besides medicine I have no other skills I can use to make a living. I am broke. I refuse to become homeless. Last month I applied and qualified for food stamps. Next week I am starting a $10.15/hour job as a UPS package handler while I am looking for other better opportunities.
Each year about 5% of US graduates do not match to a residency and have nowhere to go. There are many reasons we did not match—most commonly because of academics. If I were a program director, I would interview the best applicants and rank them accordingly. I just believe unmatched doctors must be given other opportunities to make use of their acquired knowledge instead wasting it in a warehouse or a grocery store.
If fresh college grads with 2 years in PA school can become providers under a licensed physician why can’t someone who made it through med school in 4 years function at the same level? Having an MD degree without a residency is like having a felony record. No one will give you a job. Having an MD degree without a residency dooms you to struggle in life. I wish I didn’t have the heavy weight of the MD degree on my back.
I hope marginal pre-med students will read my story and make a rational decision before applying to medical school. Med schools want to fill their classes because they know the more students they have, the more money they will make. As they collect your tuition, they will tell you they are nonprofit institutions.
No med schools will tell pre-med students the drawbacks such as the scarcity of postgraduate training as med school class sizes increased 30% since 2000. Most schools only publish lists of students who matched successfully and fail to mention those who don’t match. Pre-med students should be told what happens to all graduates of each med school.
My story may not be relevant to pre-meds who have demonstrated great potential in medicine (GPA, MCAT, and motivation). The problem is some med schools can’t fill their classes with 100% smart kids. What they do instead is lower their standards to get more students to fill the class. Why? Because they want to make money and are not held accountable.
If they can’t recruit students who can become licensed physicians in the US, the classes should be left unfilled. What is point of educating someone and giving him a piece of paper that can’t be used? These institutions should be held accountable for tuition and fees if a medical graduate attempts to match to complete his training but failed. This will force them to dismiss academically or professionally unfit students from medical schools before they accrue massive loans.
I don’t see how the schools could ever be forced to do what the writer wants.
What do you think about this essay?
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.
I too cannot match. I’ve graduated 10years ago. Completed all 3 usmle steps. I have been in the same situation as the author. In my case, I had planned to start my family before applying for residency ( I had heard the residents complaining how hard it was to do residency with a baby). After having my child, I applied but didn’t match.
My husband has a great job, thankfully but my heart breaks that I cannot practice medicine, be a physician assistant or a pathologist assistant or pretty much do anything, rejection after rejection. I’m still tearful when I see anyone walking around in scrubs or when I visit for my annual checkup.
Even research would cheer me up a bit but no luck there either.
There needs to be a job market for med students having passed boards but not matched. As the writer said a PA is allowed to work after just 2yrs with far less knowledge. I’m a Carib grad, unmatched, in debt, depressed and unable to find work in SoCal even when leaving MD off resume. I was top of my class when graduated but took my step1 twice. Now I’m banished to cave even though I know I would’ve made one hell of a physician 🙁 it’s the reality, 5 years has passed and I’ve given up, my poor wife works, and I do odd jobs.
Sol, I feel so sad for you. I wish I could give you some useful advice, but I have none. I wonder how many others are in the same predicament.
There is absolutely no reason why MD’s without a residency spot shouldn’t be able to sit for the PA licensing exam – NONE!!! Where is the AMA in all of this? So many PA jobs in every part of this country go unfilled. If there is a health provider crisis in this country it is the fault of the bureaucratic governing bodies of the AMA and the NCCPA – all making money with their individual certification scams. What a tragedy…and where are the articles written about this glaring inefficiency of medical care?
I have been unmatched since 2013 and have run into the same issues as the author. Luckily, I was able to get me Assistant Physician License in Missouri due to a grandfather clause inserted in the legislation last year allowing those who met the 2014 criteria to apply. I am also in the process of creating a support group / association for those who are unmatched so that people don’t feel so alone in the process. There are many people that have given up home and that data can not be found on the NRMP website. I am not even applying to ERAS this year. All of the unmatched graduates should know that you are not alone. So many people are afraid to speak up because of fear of retribution.
I have been unmatched since 2013 and have run into the same issues as the author. Luckily, I was able to get me Assistant Physician License in Missouri due to a grandfather clause inserted in the legislation last year allowing those who met the 2014 criteria to apply. I am also in the process of creating a support group / association for those who are unmatched so that people don’t feel so alone in the process. There are many people that have given up home and that data can not be found on the NRMP website. I am not even applying to ERAS this year. All of the unmatched graduates should know that you are not alone. So many people are afraid to speak up because of fear of retribution.
You hit the nail on the head. It would be one thing if unmatched grads could work in nonclinical positions – but this is the immense irony of the entire process – after gaining so much valuable knowledge in medicine, after getting M.D. next to your name, you are unemployable. Unable to work as an MD, NP, PA, etc… but on top of that you cannot work in the fields of health insurance, in medical management, in pharmaceutical companies as sales reps or scientific advisors – these positions are reserved for physicians with experience and connections to the industry. There is literally no way to earn a decent living right out of school if you do not match. That is the true travesty here, it’s not ideal to be prevented from entering clinical medicine, but it’s outright inhumane to prevent these grads from paying back their loans and putting food on the table.
I’ve said this for years: something has to change in terms of costs for universities AND people trying to enter the medical field. We just keep bandaid-ing everything without real revamps in the system. There are real people whose lives are being ruined from this!
What’s the solution? I can’t think of one.
Can any IMG get into residency match at age 57.
Or should stop preparing for USMLE
I would never say “never,” but it would be extremely difficult especially if it has been a long time since you graduated from medical school.
I am so sorry about your situation and totally understand as my husband also has 400K in loans and hasn’t been able to get a residency spot after 3 years. It angers me to read what some commenters are saying about…this person probably doesn’t speak English or stinks or is socially awkward. My husband is American, went to undergrad at Tufts and University of Pennsylvania (for pre med) and SGU for medical school. He’s good looking and well liked by everyone he meets….so why didn’t he match? He’s been out of school for a few years now….his test scores are not at the top ….which means nothing in terms of being a good resident or not. It’s awful that people like my husband can graduate medical school but aren’t even allowed to function as a mid level provider. There is a doctor shortage in this country yet people can’t even get a spot in residency since there aren’t enough spots!
See my reply to “Michael” in the comments section of this post.
I love how the culture of hazing, bullying and blame is alive and well in the medical profession. These comments are revealing of why many patients don’t like doctors and many doctors don’t like their profession. According to from the Centre for Global E-Health Innovation at the University of Toronto, the number one desired trait of a doctor is, “respect people, healthy or ill, regardless of who they are” not their score on a test. I don’t see much respect for this brave doctor that stepped forward to tell their story. This artificial scarcity of residency positions was pushed by the AMA in the 1997 Budget Act to limit funding from Medicare. If you want to blame anyone for why this person can’t practice medicine, blame yourself. Most doctors that decry the standards of new doctors are singing the same songs that were probably sung about them when they were new to the profession. Shame on you.
This is a discussion I was JUST having this week. I’m not a doctor, but I have a significant other in med school right now, so I see first hand what our “future doctors” look like. Some in my opinion, are not doctor material and lack MAJOR social and human skills. Just from the tone of his essay/report/rant I can there are other issues as to why they didn’t match.
Reasons to consider.
1. Socially awkward or a Gossip Queen
– If you have “no other skills to make a living.” You can’t blame your med school for that. My boyfriend was a biology major as well. He has leadership skills, hard working skills, math and science at a high level, and people skills. He could open a taco stand and in one year have turned it into a franchise. Of course, this is exaggerated, but he succeeds in whatever he does. THAT is what will make him an amazing physician.
2. An &*@! or “Negative Nancy” personality
-I’m sorry, but some doctors are the biggest jerks. Self-centered, condescending and rude. How did you treat the nurses, or even the janitor during your rotations? Or even your fellow med students at these rotations? Yes, they are competition, but do you think attending aren’t looking at that?
3. Lack in professional demeanor or attire.
-I get it. Med school sucks. The last thing you are worried about is your outfit. But when you are doing your rotations and shadow sessions, what are you wearing? Is your hair even brushed? Presentation is EVERYTHING.
4. Poor hygiene or physical health.
-You shouldn’t smell like a cadaver. If you smoke cigarettes, you better hide that. Also, if you’ve let your physical health go, you better put down that chicken wing and hit gym. Who wants to take health advice from a doctor in worse shape than them? It’s like going to an aerobics class and the instructor is out of breath before you.
5. Social Media
– So many people forget this piece. What is your social media story? Are you doing keg stands or taking hits from a bong? (I hope not for your sake) Do you share articles publicly that could be deemed as offensive? this is where I can chime in, social media is my career. You better have a squeaky clean social media presence, but I can guarantee you, employers (hospitals, doctors ect.) are looking at you.
There are strong evidence that foreign born/graduated strong accented physicians take better care of patients than US graduates. This person does not know the reality. He did not adjust when he failed. He had wrong expectations of himself.
I am so sorry for those who are not able to receive a medical job due to these harsh conditions this world is so crazy these days and those graduates who have put their blood, sweat, and tears into trying to go a better route and spent all those pennies and dimes just to get through medical school you can all see that this world is just a scam.
I refuse to believe someone can’t scramble into a prelim year somewhere. There are literally 100’s of unfilled prelim spots throughout the country and after doing one year of residency he could become a GP or whatever else he pleases. There are plenty of better options than working for UPS.
You have NO idea what you are talking about! 100s of unfilled prelim spots? Where are you getting your information? Obviously not from the NRMP because I have been going through the list of available slots for ANY specialty all week and there is virtually NOTHING available and THOUSANDS of grads and FMGs looking for spots. Oh and Get a job as a GP after a year…” You are clueless. What planet are you on?
According to the NRMP Advance Data Tables for 2017 just released today, there are 1161 unfilled positions in all specialties with 508 of those positions being “Surgery Preliminary.” The bad news is that there are more than 8200 unmatched applicants. Lots of folks will not obtain residency positions this year.
I sent a comment ovr an hour ago – will it be posted?
I am a retired physician and I work with immigrant and refugee physicians who are trained overseas and who have come to this country to escape war or persecution. They, like this writer, have not matched to residency positions in spite of passing all the USMLE exams and obtaining clinical experience which is difficult to find and is most often rarified to observerships that do not connect well with the Match. Furthermore, most have practiced in their home countries and are more than five years past their graduation dates (though not their USMLE completion dates). The writer states that US graduates have increased. There have been more than 18 new medical schools developed in the past 18 years, but because the federal government funding, through Medicaid/Medicare allotment, has not increased since 1997, there are now not enough residency positions for the US graduates, let alone international graduates. This impacts medical school graduates like the writer. At the same time, there is a physician shortage in this country, especially in rural and underserved areas, that is only going to worsen. What the writer says about trying to get jobs with an MD degree but without a license is true for our doctors as well. One of our physicians sought a job with the department of health, only to be told that she didn’t meet the minimum requirements – which in that case was a high school diploma. (?!) I do not believe the problem lies with the writer, but with the system that allows a bottleneck at the residency level. I wish him the best of luck. He deserves it.
This post is missing vital information.
What were the author’s Step scores? Did the author fail Step 1 or 2? Did the author fail any courses in med school, or have to repeat classes, or take longer to finish med school than normal? Were there problems during clinical rotations with knowledge or professionalism?
If any of these are true, then I am sorry to say that this person would usually be considered too much of a risk to take into a residency.
I have been a faculty member for 8 years. This is the real world, folks. If you are not cut out for the job, academically or otherwise, you are not going to get the job.
You should be ashamed of yourself. Someone gave you a chance. Not everyone is born with a golden spoon and a single failed courses in 20 years of education or a step does not define anyone. People like you promote nepotism in medicine and eroding the core of the profession in our country. Every single person with “connections” matched into residency from my class even if they had a failed grade or step. Professionalism should be the only reason to discard someone. Academically if you’re able to pass some of the hardest examinations in the world on your first or second try you are cut for the job. Soon itll be hard to see a doctor and all youll get is PAs and NPs with half the length of USMLE exams and online schools treating you because of attitude like yours.
So this person graduated med school at age 35. He or she claims to have no other marketable skills at have $500,000 in debt. A few questions:
1) What the hell did this person do from age 21 to age 31 that allowed them to get accepted to medical school but yet left them unqualified for anything other than a minimum wage job?
2) How does someone rack up $500,000 in loans in 4 years? That’s 125,000 a year taken out.
3) What programs was this person trying to match to? I find it hard to believe that they couldn’t even get into an FP or IM program anywhere in the country.
My mom graduated when she was 35, because she was a single parent it took her a little longer to finish school before she could even apply. Despite her graduating she is still not able to match for a residency four years in a row.
I’m sorry to hear about your mother. I’m afraid the further away from clinical medicine she gets, the less chance she has of matching. I hope she has found some meaningful work and is not in too much debt.
If youre so misinformed please dont comment. FM and IM are extremely competitive for Carribean graduates because theyre basically competing with applicants from all over the world.
3xs unmatched says issue is most likely with him. This sounds like a bunch of excuses and whining about debt.
Blame the candidate for trying not the archaic system. No one loves debt. Medicine was a noble profession once but people like you are eating it away. Artifical residency bottlenecks to keep physician compensations high and negotiable are the reason America lacks quality ethical physicians.