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Medical schools are producing more graduates, but residency programs have not kept pace, leaving thousands of young doctors "chronically unreached" and heavily in debt.
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dr Kristy Cromblin knew that as a descendant of Alabama tenant farmers and the first person in her family to go to college, making it into medical school could be an unlikely dream. Her parents watched in proud disbelief as she got closer to that goal, enrolling in a medical school in Barbados and enlisting in the military with plans to one day serve as a flight surgeon.
Then came an unexpected hurdle: a controversial divorce led to Dr. Cromblin dropped out of medical school for seven years to look after their two sons. In 2012, she returned for her senior year, excited to complete her exams and apply for a residency permit, the final step in her education.
But no one had Dr. Cromblin said that hospital residency programs, which have been inundated with an increasing number of applications in recent years, sometimes use the Electronic Residency Application Service software programSort outvarious applications, whether from students with low test scores or from international medical students. dr Cromblin had passed all her exams and got her M.D. Purchased but rejected by 75 programs. In the years that followed, as she applied repeatedly, she learned that some programs were filtering out applicants who graduated from medical school more than three years ago. Her reject stack kept growing. She is now unemployed and has $250,000 in student loans.
"There are times when you question your worth," said Dr. Cromblin, 43. “You wonder if you're useless. I had to keep encouraging myself: I'm worth it. i am useful I'm damn good."
dr Cromblin is one of as many as 10,000 chronically unsurpassed physicians in the United States, people who have graduated from medical school but are consistently rejected from residency programs. The National Resident Matching Programpromotes its high agreement rate, with 94 percent of American medical students being accepted into residency programs last year on Match Day, which occurs annually on the third Friday of March. But the agreement rate for Americans studying at medical schools abroad is far lower, with just 61 percent getting a place.
Last year the Association of American Medical Collegespublished a studywhich revealed that the country would face a shortage of 54,100 to 139,000 doctors by 2033, a prospect all the more alarming as hospitals face the possibility of combating future crises similar to the Covid-19 pandemic. Yet every year, thousands of graduates leave medical school with a virtually useless MD or DO; Without residency experience, they do not qualify for a license in any state.
Residence managers say that while they are committed to diversity and consider many factors beyond test scores, they sometimes use filters when sifting through applications because they receive thousands of applications for just a handful of places. "Nobody has the time or desire to read so many applications," wrote Dr. Suzanne Karan, anesthesiologist at the University of Rochester, 2019blog entry. "It makes my work a lot easier if I can filter your applications by M.D./D.O./foreign graduates."
But dr William W. Pinsky, executive director of the Educational Commission for Foreign Medical Graduates, which accredits graduates from international medical schools, said residency directors who belittle foreign medical students are missing opportunities to diversify their programs.
"I understand that program directors have to do what they have to do," said Dr. Pinsky. "But if they set up a filter to skip international graduates, they're cheating themselves."
striving for help
The pool of unsurpassed physicians began to grow in 2006, when the Association of American Medical Colleges asked medical schools to increase their first-year enrollments by 30 percent; The group also called for an increase in federally supported residency positions, but these remained capped under the 1997 Balanced Budget Act. Senator Robert Menendez, Democrat of New Jersey, introduced theLaw to reduce the shortage of established doctorsin 2019 to increase the number of Medicare-supported residencies for eligible medical school graduates by 3,000 per year over five years, but did not receive a vote. In late December, Congress passed a bill that would create 1,000 new Medicare-supported residency spots over the next five years.
dr Adaira Landry, an emergency room physician in Boston, said that of all the young doctors she's mentored, those who have excelled are the hardest to support: "They want to be part of our healthcare system," she said. "But they have this boulder blocking them."
At some point, Dr. Saideh Farahmandnia kept track of the number of emails she had received with residence permit denials. Still, she could recall the poignant feeling of arriving at Dominica's Ross School of Medicine in 2005, thinking she was "the luckiest person alive." She had grown up in a religious minority in Iran where access to higher education was restricted. When she passed her license exams, she enthusiastically called her parents to tell them they had raised a doctor.
After med school, she spent two years doing research with a cardiothoracic surgeon at Stanford, thinking it would make her residency applications more competitive. But she applied to 150 residency programs, ranging from rural to urban community hospitals, and received 150 rejections. She applied every year until 2015, when her mother suddenly died and she took a bereavement hiatus.
"You leave your family to follow your passion and promise that you will help the country that adopted you," said Dr. Farahmandnia, 41. "You end up with $300,000 in student loans and a degree that cost so much of your life and precious time with your mom."
According to the Association of American Medical Colleges, the average medical school debt for students graduating in 2019 was $201,490. Students who fit into an intern position soon advance to become attending physicians, earning an average of nearly $200,000 a year. But unsurpassed students must strive to find other areas of work that can help them pay off their debtsDebts.
dr Douglas Medina, who graduated from Georgetown University School of Medicine in 2011 and couldn't keep up, says he pays at least $220 in loans every month, though some are now on pause. "Just a few weeks ago I was trying to decide between a student loan or a stroller for the upcoming baby," he said. "Not only are our careers being ruined, but our families as well."
"The Cold Taste of Reality"
Students graduating from American colleges choose to study medicine abroad for many reasons. Some fear exams and prefer to apply to schools that do not rely on MCAT scores for admission. others are drawn to the warmth and adventure offered by schools in the Caribbean, which tend to have acceptance rates ten times higher than American schools.
But many applicants, particularly those from families unfamiliar with the intricacies of medical education, say they are not warned about the low agreement rates for international medical students.
"When I graduated, I got the cold touch of reality that all my credentials don't matter because you can't get past this matching algorithm," said Kyle, an international medical school graduate who asked that just be First name is used because he applies for a stay again after an initial rejection.
The most frustrating thing, Kyle said, is not being able to work when he's aware of the dire need for black doctors like him, especially in places like Atlanta, where he grew up. "It really hurts because everyone thinks I should be a doctor," he said. "They saw me pass my exams, they celebrated with me."
dr Pinsky, of the Educational Commission for Foreign Medical Graduates, said the organization works with the World Directory of Medical Schools to ensure international schools describe their credentials more clearly and honestly.
"Unfortunately, there are schools that may exaggerate the success of their graduates on their websites," said Dr. Pinsky.
The 61 percent agreement rate for international students may underestimate the problemexperts say, because medical students who do not receive interview offers are not included. Including these students, the agreement rate for international medical students can drop as low as 50 percent.
The directors of the residency program said that in recent years they have increased their efforts to look at candidates holistically. "Just getting A's in college and perfect test scores doesn't make a perfect applicant," said Dr. Susana Morales, associate professor of clinical medicine at Weill Cornell Medicine in New York. “We are interested in the diversity of background, the geographical diversity.”
Stand on the sidelines
Some international medical students who are struggling to get together have sought alternative routes into medical work. Arkansas and Missouri are among the states that offer resident physician licenses to individuals who have completed their bar exams but have not completed residency. Second-to-none physicians who would like to use their clinical skills to help during the pandemic said they have found the opportunity to serve as interns particularly valuable during the crisis.
After failing a first attempt at a licensing exam and then passing her second attempt, Dr. Faarina Khan, 30, excluded from the matching process. Over the past five years, she has spent more than $30,000 in residency fees. But with a resident's license, she was able to join the Missouri Disaster Medical Assistance Team in the spring and help at medical facilities where employees had tested positive for coronavirus.
"Hospitals need to recognize that there are people in my position who could be coming into work within the hour if we get a call," said Dr. Khan. "I didn't go to medical school to sit on the sidelines."
A handful of states are considering legislation that would allow for similar licensing. This position typically pays about $55,000 a year -- much less than a doctor might make -- making loan repayment difficult but allowing medical school graduates to keep up with their clinical training.
dr Cromblin in Prattville, Alabama, felt a similar urge to join the Covid-19 frontline in the spring. She had defaulted on a loan and had little in her bank account, but as soon as she received her stimulus check, she bought a plane ticket to New York. She spent the month of April volunteering with the medical staff at Jamaica Medical Center in Queens.
She applied again this year for a position as a resident, although she says her sons have a hard time believing their mother will ever become a practicing doctor.
"Every time I get a rejection letter, I go through my positive affirmations," she said. "I say, 'There's a place for me, it just isn't the right one.'"
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