Monday, March 23, 2015

NOT A DOCTOR, JUST AN M.D.

In what is presented as a success, the 2015 Match, where medical students become doctors and find out if they will be accepted for residency, is over. It’s over and I am one of the 1,093 U.S. students that was rejected by every place that I interviewed. This year I packed up my family and we traveled across the U.S. in an annual cross-country pilgrimage to interview at residency programs. We couldn’t afford to fly. My husband, my infant son and I drove in a 15 year old station wagon, breaking our change jars to sleep in roach motels so that I would have a chance to give them a better life. It was an exhausting journey followed by an anxious month-long wait to find out where we would be living for the next three years. Instead of a better life, the National Resident Matching Program, Oregon Health and Sciences University and the American Medical Association have left us on the curb with over $400,000 dollars in debt and no way to pay it back. A doctor without a residency is unable to practice anywhere and although I hold the title, this is probably the end of the line for me. I labored and sacrificed ten years for a change in my life and I feel like a part of me has died.


After being rejected from the Match, I got to participate in the Supplemental Offer and Acceptance Program (SOAP), a mop up for the residency remainders where you can’t call the programs but they’ll call you if they want to and usually they don’t. You have a one in four chance of getting anything in what is an operatic drama where you sit by your computer and click refresh on your browser hundreds of times a day until you just know that no one wants you and it’s over (I’m paraphrasing an anonymous posting off of one of the student doctor forums). But not really. At the end, there is the Post-SOAP scramble, the last push to find a spot anywhere. That is when you go through the list of all of the programs in the U.S. and you try and get ahold of anyone from any of those programs and if they answer it’s usually a curt, “we’re full,” followed by a click and a ringtone. This process can take weeks and it is emotionally draining. But you do it anyway and then you get anyone who has any influence from the rotations that you did as a student that is willing to do the same on your behalf. When you’ve exhausted every opportunity in the U.S. you look abroad as far as you can imagine and justify packing up your family to move to Saipan if they will just answer your calls, which they don’t. And that is it, it’s over and you are done.


This year about 41,000 people applied for a little over 30,000 positions. This is an all-time high for applicants, but nowhere near what we need to reach if the U.S. is to keep enough doctors for people to have fair access to care. Whatever you think about the Patient Protection and Affordable Care Act (otherwise known as Obamacare), none of it matters if you can’t actually see a doctor. According to a recent report by the Association of American Medical Colleges, by 2025 we will suffer a shortage of 91,000 doctors. Many doctors are retiring early or just quitting out of frustration with the current situation. Visits are shorter and the wait to get one longer now than ever before. In Oregon it currently takes an average of 13 to 20 days to see a physician (depending on the specialty). If you were sick when you called for an appointment, you had better be cured by the time you get one. Medical schools have responded by pumping up their numbers but residency spots have not corresponded to demand. Even if, like me, you manage to graduate from a top-ranked program like OHSU, a blemish (we call them deficits) on your record means that you will not go on to serve your community and all of your talents and skills will be wasted. The competition is fierce today with a large pool of qualified candidates. I did my best in interviews and I tried to make them understand that I have a genuine desire to practice Family Medicine and focus on under-privileged communities. Not everyone who goes to medical school has the need for a large bank account and a diminutive sports car. Most of us regard this as a calling, a way to serve those who need healing and care. Hour for hour, when your investment in education and training is considered, a physician’s assistant can make more money than a family doctor. A Nurse Practitioner does pretty good too.  I chose to take this path because I wanted the autonomy to make health care choices for my patients and be responsible for their healing as a doctor.


Oregon is not alone in its shortage of physicians. Some states, like Kansas, have circled their wagons and don’t let anyone from outside of their own schools into these precious residency slots because they want to keep their own doctors in their state when they are done with residency. I was able to interview in Kansas due to my MPH at Kansas State University and encountered only Kansas University Medical School graduates during my interview. In Oregon it doesn’t matter where you went to medical school, as long as you fit their profile you will get a coveted spot in the Pacific Northwest (PNW).  U.S. News and World Report rates OHSU as the fifth most expensive medical school in the world. In the world. With the new campus that went up on the South Waterfront tuition is likely to climb. Yet in my case, despite having the recommendation of a Chief of Surgery from OHSU, after I interviewed for the Preliminary General Surgery program I wasn’t even on their list of possible candidates and they had three spots left open at the end of the Match. I want to do Family Medicine but the Surgery Prelim program interviewed me because of the personal recommendation. I would have really enjoyed working there but OHSU wanted anyone but one of their own to fill what is essentially the bottom of the barrel in residencies.


This is because programs are risk averse. Risk averse is code for everyone wants the same thing - perfect test scores, good teeth, fit and possibly sporty. In Klamath Falls, the OHSU rural track program that I interviewed with, they spent more time asking me about what kind of extreme outdoor adventure activities I was into than actually talking about you know, medicine. As a nearly 40 year old mother of two children with some baggage, I don’t think I fit their mold. Oh, and I bombed the USMLE (a test of tests), until I was diagnosed with ADHD and given testing strategies to sit for eight hours a day in a cramped room with bad fluorescent lights. I knew the answers but I had a hard time sitting through an eight hour computer exam.  I passed the two required USMLE exams to enter residency. I went ahead and passed another USMLE test that I normally wouldn’t have to take until the end of my intern year of residency to show what I could do with a little training. Oh, and I went ahead and got an additional degree in Public Health (MPH) just to sweeten the deal.


Failing a test is a big deal for any program to overlook, but my value as a doctor and a student should not be only based on a test that took less than 24 hours of my life. I’ve got ten years of experience as a nurse. Four top-of-their-field doctors that I worked with wrote me strong recommendations and some of them even got on the phone to help me track down a position. I have skills and I’m still eligible to be a doctor in Oregon, I just won’t receive the chance to do an intern year to prove my worth.


You see, I’m a two-time loser. I failed to find a position last year and the further away you get from your graduation, the less attractive you are as a candidate. Programs would rather choose a person who couldn’t get into a U.S. medical school and spent their education in the Caribbean (we call them IMG’s - International Medical Graduates) than a student with a “hyperkinetic disorder”. They might resent this depiction, but I made it into a U.S. program and I’m proud of that. I’ve known for years that I have to work harder than most people to pass tests, but I usually pass them because I’m persistent and smart. I never got an actual diagnosis for ADHD before I took the USMLE tests because of the stigma attached to the condition… that and the $500 dollars that I simply did not ever seem to have. It’s hard enough to be older, poorer, a single mother and of mixed heritage (for the record, until recently I was a single mom  who had raised a happy and healthy now 20 year old daughter). When OHSU cancelled their student diversity program I was a bit shocked, but not surprised. I never realized much benefit from it anyway. I do wonder if my pregnancy while interviewing last year affected their decision. This year I was nursing and despite having a spot-on husband who wanted to take the role of Mr. Mom, it is possible that the family-in-tow affected my career opportunities. No program could ever legally admit to this, but the question does linger. I made plenty of mistakes in school but I did well on my rotations and got decent grades. I didn't seek out help for my testing issues early enough. I needed guidance and I didn't look for it in time.


How did it come to this? Isn’t OHSU the shining beacon on the hill that represents what is good and forward thinking about health care in our state? Portland is the city that works hard on its reputation for being inclusive. Don’t we take care of our own? Not really, not unless you come from money. If someone would have told me that my chances of getting into and succeeding at medical school were based on what my parents did for a living, I wouldn’t even have applied. The Association of American Medical Colleges is well aware of this problem. The average medical student in the U.S. comes from a family in the top 15% of income earners. I come from a poor family. In my family you become a nurse if you want to aspire to a better life. In fact, I was a nurse for 10 years, a pretty good one. My mom was in the military and a nurse before me. I remember being told that nurses can’t be doctors but I didn’t let that hold me back. I might have been wrong. Since it is impossible to work while you are a medical student at OHSU it was unfeasible to maintain my license. I’m not even a nurse anymore.


What can the 1,000 odd U.S. graduates and the 8,000 plus IMG’s do with an M.D. and no residency? Nothing. Not a thing, seriously. Try googling it and you’ll see suggestions such as - go into pharmaceutical and medical equipment sales, consult with corporations, become an entrepreneur or have you thought about research? With the exception of sales (and if you’ve met me, you know my tolerance for salespeople is not high) these other opportunities don’t exist. You can’t go into research unless you’ve done research before you went to medical school. You can’t be an entrepreneur unless you know the first thing about business (or come from money). Consulting is just another term for “I’m unemployed, but I still have a clean shirt to wear in public” unless you have a substantial network. Most people in this position go on to other fields and leave this depressing chapter behind them to start again. Almost no one talks about failing to match. For people like me who didn’t have anything to begin with, the repercussions of the decision to go to medical school is just beginning.


Have you ever been behind on a student loan? Have you ever been behind on a doctor’s burden of student loans when they know that you will never be a doctor? They own you. I will never qualify to buy a house. It’s likely that I’ll always drive a junk car (I would bike everywhere like I did in med school, but I can no longer afford to live in the heart of Portland). While at OHSU I sold plasma to pay my electricity bill. Not once, but many months. I even joined the military to get help, but they kicked me out when they saw my credit score. That actually happens. I joined the Air Force and despite telling them that I have bad credit and was declaring bankruptcy, they swore me in. This was right around when we were pulling out of Iraq (which could just be a coincidence) but Uncle Sam booted me after basic training and asked for their money back (and not in a nice way). It’s hard to know that you won’t be able to pass on a family anything to your children.


Why the bottleneck? If we need more people like me, then why isn’t OHSU and the rest of the medical community filling the gap? Why build more schools when we just need more residents? We’ve been stuck near the same rate since the 1990’s. The World Health Organization estimates that there is a shortage of 4.3 million physicians and nurses worldwide. The story is the same wherever you look. Canadians come here because they can’t get into their own anemic programs. Australians look to New Zealand and the Irish go to the UK if they can but none of those countries have enough residencies to provide for their own needs anymore. It’s spooky. It is harder to get into any program that reciprocates with the U.S. than it is to get into a residency here. This lack of health care providers is not an abstract phenomena. There are real human costs - people die. According to a study by the U.S. Senate SubCommittee on Primary Health and Aging more than 45,000 people die in the U.S. each year. Based on population, thats 563 people in Oregon who die every year because it took them too long to get a doctor’s appointment. Every day there are almost two preventable deaths in Oregon. Because of our under-served rural population that number is probably much higher. Even with all of the public and private funded residencies not one of those doctors goes further East than Klamath Falls or Hood River. The majority of our state sees no benefits from these programs.


At about $45,000 - $52,000 dollars a year for 80 hours a week of work, Medical Residents are a bargain. If you end up in the emergency room late at night, chances are you are seeing a resident. In a hospital you are more likely to see a resident first. At a free-clinic, probably a resident. The workload is legendary and the stress incredible, but we fight for these positions. Why wouldn’t OHSU and Oregon want as many of these as we can get? We can put up or take down billboards that say “Oregon Cares” but it is the doctors, residents, nurses and staff that do the actual caring. I may have a lot to say about OHSU and its politics, but it is a good school and everyone there is dedicated to quality. There are incredible teachers who took their time and energy to make sure that I had the substantial medical knowledge that I need to save your life. OHSU, for the most part, made a strong and positive impression on me. It is a top-ranked school and they’ve built a shiny new building to prove that.

The problem is - what will OHSU do when there are more and more students like me? Most medical schools are increasing their student load, but residencies still fall far behind in capacity. Would fewer people die if I would have been able to get a spot? I can actually say, yes. I would have saved lives. It is what I was trained to do. With more doctors people will get the care when they need it. Instead, I’m scrambling for a place on a subsidized-housing waitlist near felony flats and applying for a SNAP card (food stamps). We’ve blown most of our resources on this eventful journey. I love my family too much to give up. I'll keep calling and applying and working my connections for any chance out there but I’m also going to use my MPH, not my MD, to find any job I can. Chances are something will open up at a rural county in a public health position where I can make $28,000 and a difference. I’ll maintain my dignity this way but this is probably what my student loans will cost a year. I’ve been through worse. Like most overeducated-underpaid Portlanders, I’ll get by somehow - really, I will. Don’t we always?


-S

creative commons licensed - reproduce with author's permission

86 comments:

  1. It takes a lot of courage to go through what you have in the last two years. I love you and am proud of you.

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  2. When searching for articles about the SOAP, I was hoping for personal stories and found only depressing statistics. Thank you for risking vulnerability and telling your story. I hope others do the same.

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  3. Hey, consider entering General Preventive Medicine and Public Health. You've already got the MPH. This places you for leadership roles in various population-health positions. You'd get paid a hell of a lot more than $28k. It's one of my fields and gives you enormous flexibility for job-finding. Google the various residencies, call them, or contact the ACPM or ABPM and ask for a list of programs.

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    1. I went through the list and saw only a handful that do PGY-1 positions but this could be a good recommendation. Certainly worth asking about.

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    2. Also, you could get PGY-1, and have to apply for residency later.

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    3. Look into Meharry Medical College. I know the cycle has passed, but HBCU's tend to be more family oriented anyway. Howard University, Morehouse and Meharry

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  4. It looks like there are some places where you can work as an intern or physician assistant without the match- for example, www.latimes.com/opinion/op-ed/la-oe-0808-caplan-doctor-shortage-20140808-story.html

    Good luck

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    1. These licenses currently are not available. According to the MO Medical Licensing Board they may become available sometime in 2017.

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  5. Did you try applying to any branch of the armed forces? They're always in need of more docs. Especially if you're already a med school graduate.

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    1. In the article she states she actually got sworn in, did bootcamp, and then the kicked her out due to her bad credit stemming from her educational debt...

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    2. The armed forces consider you a security threat if you owe too much money.

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    3. I know that you can't get a security clearance while having debt but I have never in my life heard of somebody getting kicked out for having school debt.
      I knew a lot of guys going in with med school loans that were on repayment programs with no problems at all.

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    4. It happened because of prior non-school related debt. I appealed it once and filed bankruptcy shortly afterward but they discharge me before a second appeal.

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    5. On another thread I read that the MATCH percentages are lower than what is put out by the official mouthpieces. When you factor in the no rank list group and the withdrawals the actual statistics for AMGS range from 63 to 75% and for IMG/FMG the number is around 35%. I am a high school math teacher. I did the numbers myself and fact checked the numbers. He was right. The 35% also includes thousands of AMGS that did not make it in the general group set that did match. Despite these catastrophic numbers I am interested in the med school challenge. If I don't match, no worries because the completion of an MD degree will be an achievement and an end in itself. At this point you must begin to get creative. After reading your beautiful article, an idea came to mind. Have you thought of pitching the idea of being a free resident to any hospital or health care setting that would take you? I was wondering why would you be turned down? If residents are a bargain at under 50k/year what about an unpaid resident at 0/year? It's a thought I would pursue if all other options were closed.

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  6. http://www.reddit.com/r/medicine/comments/303m6p/not_a_doctor_just_a_md_failing_to_match_2015/

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  7. Where does the AOA or osteopathic physicians play into this? i.e. competing for M.D residencies

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    1. The generalization is that MD > DO > FMG > IMG.

      However, there are several factors involved. Step scores in particular if good enough can trump this hierarchy. Which is why, justifiably or not, they are considered to be the most important factor in obtaining a residency.

      Other factors such as citizenship, grades, etc all have a role.

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    2. DO>MD>FMG>IMG

      DOs get about 200 more hours of training. Many that do MD programs sit both the COMLEX and USMLE.

      The AOA has increased it's funded residency spots in primary care the last 5 years running (until this year, 2015). They are trying to figure out what is going to happen with the AOA and ACGME merger.

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    3. FMG = IMG ; same thing, different names

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    4. AOA has their own residency programs as well. Although, the ACGME and AOA are merging

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    5. AOA has their own residency programs as well. Although, the ACGME and AOA are merging

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  8. Ugh....

    I failed a course as a MS1 and now I am scared I'll be in your position in 3 years.

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    1. Several people in my med school (PCOM in Philly) class failed at least one or in some cases 2 courses during OMS-I... they remediate the courses, and went on to barely pass the COMLEX, and in some cases the USMLE, and went on to residency. 3 of 10 that I knew that failed a major course (13 credit hour+) went on to become Chief Resident in their programs. A one time failure is not going to prevent you from getting a residency... it is the whole presentation of how you handle your life. ThE residency directors are not looking for perfect people, they are looking for physicians with as little baggage as possible; able to handle debt, able to handle a demanding schedule, able to pass the Step 3, able to manage thier children and their issues... while on the surface the writer of this article looks like everyone was against her, if you look deeper, she has had issues with meeting the demands of life... not a good presentation to a residency director. You will be fine, as long as your personal life does not interfere, or give the perception of interfering with your success in residency training. Good Luck.

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  9. I am an IMG and I have faced the same situation for 3 years. But you have a MPH degree, use it... In any good university hospital there will be many clinical research jobs for which they will love to have you. Try working as an epidemiologist at local or state level. None of these will make you resident, but they will help you pay bills and if you are lucky next year you will be a resident.

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    1. I don't know... what I hear of researchers is that they are paid so little that I believe their salary would literally only cover her monthly student debt payments, without rent. When we started residency, my husband's post-tax take home was exactly equal to our rent plus our student loan payments, and we started at $52,500 back in 2009, which I believe is significantly more than you can make doing post-doc type research :(

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    2. Oh my god which Caribbean? Can you apply for residency again? Or no?

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  10. Thank you for sharing your story - it highlights much of what is wrong with medical education in this country, particularly with the madness of the Match process. As someone who successfully matched into a FM program this year who is passionate about healthcare transformation and compassionate patient care, I am deeply saddened that someone like you - whose perspective we so desparately need in medicine - will be unable to join me. I would have proudly served by your side as an intern, and I hope that someday I will still be able to call you a colleague. Best of luck to you.

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  11. I am so sorry you're going through this. It's not fair and it's not right. You're a beautiful writer and very insightful. Your positive attributes will win out in the end--you never know what the future holds. I wish you the best. As a resident now, I can tell you that someone like you truly deserves a spot. Our system for selecting candidates is broken. I wish you the best, and believe in the end good things happen to good people.

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  12. You're a great writer and your emotions come through. Consider using your experience and indie publishing to help the many people who suffer similar outcomes but don't have the strength to stand and express their feelings.

    There are many things that you can do with your MD outside of medicine. The first step to seeing all of them is to understand medical culture and reboot your brain to see how people turn pain and passion to income.

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  13. I'm sorry for what you're going through. Please look into IBR and Public Service Loan Forgiveness. You would pay only a portion of your salary for 10 years and your loan will be forgiven.

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  14. You need to know that there are other options. The Gary Methodist Hospital in Gary ,Indiana runs a family medicine program that does not participate in the match. It is one of the hospitals that I practice at; I trained at the University of Illinois Hospital and is a very similar place. We practice good quality medicine and take care of a rather complicated patient population. You have to be smart to train here . We have an exceptionally well trained and smart nursing staff. Many of our grads stay here and that is the idea. There is loan forgiveness to practice here. Some without loans go back home You may call me at my office at 219-769-7650 and I will direct you Mary Vanko MD

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  15. So so sorry to read this. My husband was one of the IMG's who didn't match in the 2014 match but was able to scramble post-SOAP into a preliminary position and he got VERY lucky and matched this year into a categorical surgery spot. But I seriously ache for you and what your family is going through. I myself have a 21 mo old daughter and was devastated when my husband didn't match initially. I hope to come back to this blog of yours in the future and see that things have worked out for you. If you want, you can read our story at
    http://thescurlockscene.blogspot.com/2014/03/the-match-soap-reality-of-being-img.html?showComment=1428462087747#c6300753226676772690

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  16. Did you ever consider the fact that there are some IMGs that are way more qualified to fill those positions than US graduates that barely passed Step1? Sorry you had to go through all of these, but matching is a statistical game and your profile didn't fit the bill. Maybe its unfair but that is how it is.

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    1. She is going to be excellent doctor. What is mostly lacking in most doctors that she has passion. Your comment is very unnecessary, You can decide if someone is more qualified based on scores alone.

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    2. Did you know that residency positions are paid for by US TAX DOLLARS? That's right - they are paid for through MEDICARE.

      If US tax dollars are paying for these positions their first priority should be to US Graduates.

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    3. Did you know that residency positions are paid for by US TAX DOLLARS? That's right - they are paid for through MEDICARE.

      If US tax dollars are paying for these positions their first priority should be to US Graduates.

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    4. Even if you got a perfect score on the STEPS, what does it matter? The insurance companies dictate to doctors procedures and medications. All your bookish knowledge is just a hoop you have to get through to practice. The elitist point you make is a non sequitur argument.

      I volunteered at a hospital and poured over hundreds of test results and procedures and medications. The pattern was undeniable. It was as simple as a reducible set of if then statements. The correlation between conditions and prescribtions was firmly established. So many years of medical school training to become an automaton.

      When I asked two of the attendings I knew they confirmed my conclusions. The insurance companies dictate to the doctors what can and can't be done. Their latitude of freedom is severely restricted. They told me the actual day to day used very little of what they learned in med school.

      So the snarly elitist point made that an IMG scoring in the 99th percentile versus a barely passing AMG is non-sequitur. The AMG can do the job just the same when the work consists of a reducible set of if then statements dictated by insurance companies.

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  17. Thank you for sharing. Missouri passed a law last year allowing MDs to practice in rural areas without a residency - the program isn't running yet, but (fingers crossed) they're hoping to get things going (and start accepting applications) by fall 2015. http://www.pr.mo.gov/healingarts.asp

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  18. Very interesting post. I just had one question about something you wrote. You said that you were contemplating moving to Saipan, but they never called. Does Saipan have a residency program? I know they have funding for a one month residency rotation through UCSF, but I didn't know they have anything permanent. Thanks.

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  19. Thank you so much for sharing your story. I went through a similar situation last year (struggled to pay student loans, considered selling plasma, had little to no money for food). I ended up using my research background and found work as a research analyst for the year. However the pay was not much even with an M.D. I used the income based loan repayment program to pay toward my loans. I think this topic should be brought to the light more (at least for support for those in this situation and knowledge that they can make it out). I matched this year in a program that was my #1 choice last year. I say all this to say, stay encouraged. I have a few friends (including my fiance) that have had similar situations. Like you said, some of us have definitely been through worse. But I don’t think you should throw in the towel. Maybe consider branching out geographically this match season (ex. southeast regions). Your story and your passion will be such a blessing to the patients you end up serving.

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  20. The professionals that are salivating ... as he says ... I don't think np's desire such patients as much as they are perhaps better equipped to care for these patients! I get excited when I get consults on patients that the doctors are asking me to manage because they simply have exhausted their tool box ... This is difficult to control symptoms ... and difficult families and psychosocial issues ... as well as undecided families as far as their goals of care. So ... I suppose I salivate at the chance to say -- hey this recommendation is what you need!

    I should also say that I like being a consultant. I do not wish to take over the hospitalist or pcp role.
    ALOKA UST-9124

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  21. Hi..
    thanks for sharing this information with us. I am proud of you.
    I appreciate your approach. Please keep sharing such post with us.
    Physician

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  22. US is being manipulated via economics to be destroyed in under 10 years time. Hence lack of funding and doctors with regards to spots.

    I have heard you can practice as a locum MD in miami, without a residency...

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  23. Wao!!! thanks for sharing your incredible story, I am in a similar situation, I would love to make contact with you, my email is khius.o@gmail.com, thanks

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  24. Great article.
    I'm applying for my 4th cycle this year.... Went to a Caribbean med school, so I'm in the IMG Boat. I Passed Steps 1, 2, 3 all on the first attempt. I applied to nearly 200 programs last year, and will apply to more this year (adding Pediatrics and Emergency Med into the mix because what else can you do?). Did a few weeks of medical volunteer work in Africa. And I'm really not sure what else to do. I'm really discouraged this year and just looking at the ERAS screen takes all the energy out of me... I'm currently working as a valet because it pays well, and I get to drive cool cars that I probably will never be able to afford... Putting my M.D. to great use, huh?
    Fingers crossed for both of us this year. Good luck and feel free to reach out if you'd like rozario1@gmail.com
    Take care,

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    1. I am sorry this has happened to you and I hope this year things have gotten better. I am working on a follow-up blog but want to wait until the match to release since I am again waiting to see if I match this year. I have constructed a plan B and C, just in case. I recently was contacted by a graduate student doing research on professionals and unemployment. and he wanted to ask other MDs about their issues with finding a residency. Please PM me if you are interested in talking with him.

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  25. I have been trying to match the past 4 cycles last year I passed Step 3 and still no interviews. US citizen with lots of experience. My Blog
    http://southerndoccarib.blogspot.com/

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    1. I am sorry this has happened to you as well. It is very disappointing. I am again waiting to see if I match this year but I have constructed a plan B and C, just in case. Please PM me if you are interested in sharing your story with a graduate student doing research on professionals and unemployment.

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  26. I love some of your comments. I am a military physician who has been practicing primary care as a flight surgeon for 6 years. I am a DO who scored in the top 5% on steps 1 and 3, have multiple published research papers (google my name), have the respect of all of my subspecialty colleagues, graduated from Walter Reeds PGY1 Neuro internship (didn't match Rads, so I was put into PGY1 Neuro), get over 200 CMEs per year [have made the most of my time as a flight sgn] etc etc. My son became sick with DOCK8 deficiency and I had to put my residency plans on hold. Since he has received his BMT, I have barely gotten a sniff from residency programs I have applied to. I would put my clinical acumen up against any PCP with the same amount of patient care experience

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  27. Hi, I hope you are having a fab holiday. Wish you all the best and hope that your journey has a successful happy future. Do let us know how you are keeping.
    Take care.

    ReplyDelete
  28. As someone that also went unmatched this year it was nice to see someone describe the emotions behind not matching. Often people when they hear about someone going unmatched ask "so what's next?" but the choices are extremely scarce. I enjoyed your commentary about calling programs for a residency position. I remember thinking how strange it was that I was about to have an MD and yet I was begging for a job.

    Maybe it's because we have been burned by the process, but I too see the bottleneck between the number of entering medical students and residency positions. I think this stems from who is footing the bill. At least in Texas, medical schools receive a certain amount of money from the government according to how many students they have. Ever thought why schools are willing to bend over backward to retain a student? Not to mention as students you are paying your way through. On the other hand residency spots are paid for by Medicare and funding for that program has been frozen for a while.

    Though the situation is less than ideal, it is what it is. The best thing as unmatched applicants we can do is give information and insight to others that have to undergo the same situation. Best of luck to you. Keep the faith.

    ReplyDelete
  29. It's been 1 year... Probably, you have already found a solution for your problem... Thank you for sharing with us. I'm proud of your courage.
    I'm doctor in Brazil. The medical school here takes 6 years. Here, we work as doctor before going to residency. So, you are a doctor even without residency training. A generalist.
    Brazil has a program to attract foreigners doctors for primary care units (family medicine doctors). You don't need to validate the licence but you can't work in other place besides the primary care unit. You don't need to have medical residency either but you need to speak Portuguese. It pays 10.000-20.000/month (Brazilian currency). I think the person can stay up 2 years in the program. The cities in the South of Brazil have very good social indicators, if you decide to subscribe for it. There is no shortage of doctors in Brazil. The difference is that the federal government pays for this program instead of the cities and states. So, it's a good deal for the cities that can use the money for other things instead of paying a doctor.
    http://www.scielo.br/scielo.php?pid=S1414-32832015000300623&script=sci_arttext&tlng=en

    ReplyDelete
  30. Hello Sara, I hope the match has been good for you this year, sincerely hope for better times for you and your little family.

    -a Fellow Portlander-

    ReplyDelete
  31. Dear Sara,

    You are an excellent writer and your story is very moving. I hope that you are successful in the match this year or that one of the other options for obtaining clinical training works out for you.

    ReplyDelete
  32. Hi Sara, I read your incredible story. You've definitely had your share of disappointment. You are a survivor for sure! Knowing the results of the Match came out this week and just wondering if the tides turned in your favor. I know it's likely, they did not, but am curious to know how you are doing. I am someone that had dreams of med school or a career in healthcare, but faced my own share of struggles with health issues from the pursuit of my goals. Hoping someone else wins. Cheers! B. Kennard

    ReplyDelete
  33. You are an excellent writer and your story is very moving. I hope that you are successful in the match this year or that one of the other options for obtaining clinical training works out for you.
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    ReplyDelete
  34. I know several people in the same boat and am trying to raise a little more attention about this terrible situation. I am actively contact legislators, health societies, and the media in my state. Please visit nomatchmd.com and join me!

    ReplyDelete
  35. I went through the same thing as you this year. I'm trying to go back to school but it's so expensive and i can't even get more loans because my previous school debt is already so high. I'm working as a LVN to collect clinical hours to apply for PA school and pay back my debt now. But it was so hard to find a job because they tell me I'm overqualified everywhere i interview.

    ReplyDelete
  36. Have you thought about trying to volunteer at a place with lots of residencies to see if that can help you get in and know the people? Also, you can do income based repayment on your loans. If you get a job and work for a government position or non profit, your loans are forgiven after 10 years. Just some ideas...

    ReplyDelete
  37. Thank you kindly for sharing your story with all of us. I am entering the match again this next year for the 3rd time, hopefully it will be the charm. I only applied to 30 programs last year and did the same the year before. Plan is to apply to different specialties as well. Notwithstanding, let us press on with hopeful expectation while counting our blessings.
    All the best to you.

    ReplyDelete
    Replies
    1. I will apply to FM, Peds, and IM.

      Delete
  38. Thanks for this great post! - This provides good insight. You might also be interested to know more about generating more leads and getting the right intelligence to engage prospects. Techno Data Group implements new lead gen ideas and strategies for generating more leads and targeting the right leads and accounts.
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  41. I am just thinking that we have to work in it, nothing it was made in a couple of years so we must work hard now. I am also thinking in all those students who want to study in another country and stay in a student acommodattion now with Brexit all it is more difficult

    ReplyDelete
  42. This is a heart breaking story but I don't think it is over. I agree that it will be more challenging to find a transitional year residency after two unsuccessful attempts in as many years. However, you have some other options. First, I would google a list or table of state laws for physician licensing. Some states will grant a license with no residency for US medical graduates, some with one year of residency, some with two years and the rest with three years. Not ever state has the same rules for licensing. Missouri comes to mind as a state that recently passed a Physician Associate law for people who graduate medical school but didn't match. You will have problems with not having a full residency. Hospitals may not credential you, insurance companies may not work with you. The answer to that is to simply hang a shingle. I would look at "Ideal medical practice" from Dr Wible in Eugene Oregon for some guidance. Also look at the newly emerging direct pay primary care physician movement. Another asset is your ten years nursing experience and a medical degree. You could renew your nursing license and then study online for your MSN/Nurse Practitioner. Sure, it's degrading. Just look at it like a bridge to where you really want to go. Remember, in most states, you can hang your own shingle and run a nice medical practice as a nurse practitioner. Don't accept insurance and you can charge the same prices that MDs are charging. Patients will respect your passion and competence. Patients don't care about credentials as much as people think. Finally, you might consider a pharmaceutical consulting contract position for income purposes only while studying for NP or trying to set up your direct pay practice. Frequently, the big consulting firms that help pharm companies run drug trials need people (MD, MPH types) to work in the field. You could check out the pharmaceutical space in Raleigh Durham NC for remote jobs in Oregon. Remember that many very smart people don't get residency slots. Try not to let it affect you personally. When I was training to be a PA, I had a hospital rotation with a very smart Indian medical school graduate. She had not matched previously and was trying an observership. Surprisingly, she didn't get a residency spot but she was probably one of the smartest doctors I have ever met. Nevertheless, you might consider that path as well, that is, the observership. Residency directors might become better acquainted with you over a six or eight week period while you impress them with you skills.

    ReplyDelete
  43. Have you considered the internado/internship option in Puerto Rico? Take a look at this website - if you speak Spanish, you should be able to research these hospitals yourself without paying the fee.

    https://residencyhack.com/about-us/

    ReplyDelete
  44. come to brazil and try the "revalida" (revaluation), here doctors are gods and make tons of money

    ReplyDelete
  45. Missouri board will accept applications FOR Assistant Physician starting January 31, 2017.
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  46. Sara - Did you match?

    Just read this story. My wife and I are sharing in your pain. She matched the first time but failed her PGY1 in Pediatrics and because they didn't tell her until after March 2016 she had to sit out the entire year. Now we have reapplied to the match, had four solid interviews, and just found out yesterday that we did not match!

    What are you doing with your life? Can we email call each other? We seriously need help and advice from someone who understands this situation.

    ReplyDelete
    Replies
    1. She has been posting on Reddit today and yesterday that she still has not matched after 1 interview this season.

      Delete
    2. My husband graduated with decent scores; good grades in med school but has not matched. He graduated in 2011. He tried 3 x and did not match and eventually have up. Now years later we want to try again except he will be an old grad and inexperienced. So nerve wraking. We would also like to communicate with others ?

      Delete
  47. https://notadoctorjustamd.blogspot.com/2017/03/still-not-doctor-just-md-first-year-i.html?m=1

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  48. Wow... this is where ND's are lucky they don't need to apply for a residency after graduation to be able to practice :o !

    -I wish you luck on finding a residency!

    ReplyDelete
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