Eric Ruark's picture


  by  Eric Ruark

A couple of weeks ago we told you about a protest by the group Doctors without Jobs outside the D.C. headquarters of the Association of American Medical Colleges (AAMC). They were in town to bring attention to the 6,570 U.S.-citizen medical school graduates in good standing who are unmatched with residencies.

The problem they face is that even with an M.D., a physician cannot practice without residency training. This leaves thousands of qualified individuals unable to work as doctors, many of who remain heavily in debt with unpaid medical school federal loans. At the same time, foreign-national physicians are being admitted into the U.S. to take residency slots that should be reserved for U.S. citizens, who are capable and qualified to work in their home country.

There is no shortage of doctors in the United States. The problem is a shortage of residencies for medical school graduates.

The work of Doctors without Jobs to publicize their cause paid off in a big way. Last week, The New York Times ran a story about unmatched U.S.-citizen doctors (The citizen part was not emphasized. We’ll touch on that later).

Entitled “‘I Am Worth It’: Why Thousands of Doctors in America Can’t Get a Job,” the Times story by Emma Goldberg gave voice to several doctors who have gone unmatched. Dr. Kristy Cromblin, whose quote appeared in the headline, was the first person in her family to go to college. She entered medical school but had to take seven years off due to personal circumstances. Returning and graduating with a medical degree in 2012, she has yet to find a residency match.

Dr. Cromblin is one of as many as 10,000 chronically unmatched doctors in the United States, people who graduated from medical school but are consistently rejected from residency programs. The National Resident Matching Program promotes its high match rate, with 94 percent of American medical students matching into residency programs last year on Match Day, which occurs annually on the third Friday in March. But the match rate for Americans who study at medical schools abroad is far lower, with just 61 percent matching into residency spots.

Goldberg points out that the 61 percent match rate doesn’t tell the whole story. If U.S.-citizen graduates of foreign medical schools who never even get an interview for a residency slot are included, the match rate may be below 50 percent.

Goldberg’s article is compelling, and there’s nothing wrong with what she included, but she didn’t tell the whole story, either. Left out is one of the main factors preventing many U.S. citizens from finding a residency match.

According to Doctors without Jobs, more than 36,000 foreign doctors have been granted U.S. taxpayer-funded residencies over the last decade. That is one of their major complaints, yet there was no mention of immigration at all in Goldberg’s story.

We should be glad that stories of American physicians who are struggling to find residency matches are being told, especially while most of the rest of the media keeps insisting there is a “doctor shortage.” We should remain frustrated that The New York Times cannot bring itself to report basic facts when it comes to immigration.

Why are foreign doctors given precedence? Because the AAMC, which represents medical schools and teaching hospitals, profits more from the processing of foreign applicants, and the Educational Commission for Foreign Medical Graduates (ECFMG) profits more by having more foreign applicants taking the U.S. Medical Licensing Examination (USMLE) and validating international doctors credentials. ECFMG will even start charging $900 per year starting next year for this credentialing changing from a one-time $900 fee for a process that cost them very little.

It may sound complicated but it comes down to something very simple: The AAMC and ECFMG profit more by bringing in foreign doctors while qualified U.S. citizens are passed over.

The AAMC and the ECFMG, however, do not set immigration policy. The fault lies with Congress, which hasn’t increased the number of residency slots in almost a quarter century. Worse, the law allows foreign doctors to take residency slots that should go to U.S.-citizen doctors, and it makes the taxpayer foot the bill. Sen. Dick Durbin (D-Ill.) last Congress introduced a bill that would have brought in 15,000 additional foreign doctors. There will almost certainly be another push at some point in this Congress to pass a similar bill.

Bad immigration policy negatively affects Americans throughout the labor market, and it negatively affects all U.S citizens, both U.S.-born and immigrants.

Consider this:

At some point, Dr. Saideh Farahmandnia lost count of the number of residency rejection emails she had received. Still, she could remember the poignant feeling of arriving in 2005 at Ross School of Medicine in Dominica, thinking she was 'the luckiest person in the world.' She had grown up in a religious minority community in Iran in which access to higher education was restricted. When she passed her licensing exams, she ecstatically called her parents to tell them they had raised a doctor.

However, Farahmandnia has “applied to 150 residency programs, from rural to urban community hospitals, and received 150 rejections.” Applying for residencies is a very costly process, adding more debt on top of medical school loans. What Goldberg leaves out is that Farahmandnia is now a U.S. citizen. Does her citizenship put her at a disadvantage? It’s an important question that Goldberg never asked.

Another doctor, Kyle, who withheld his last name, is unmatched and “unable to work when he is aware of the urgent need for Black physicians like himself, especially in places like Atlanta, where he was raised.”

Goldberg writes that “Residency directors say that...they are committed to diversity.” One has to wonder if that’s a way of justifying the rejection of diverse candidates based on their U.S. citizenship.

ERIC RUARK is the Director of Research for NumbersUSA

Updated: Thu, Mar 11th 2021 @ 7:05pm EST

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