I graduated from a U.S. medical school five years ago, but remain unmatched and with $475,000 in student loan debt for which interest is capitalizing at around $50K per year. These loans are currently in hardship deferral for which time is running out.
As far as finding a “job” while reapplying for residency, it has been extremely difficult. Temporary contract work in the gig economy offers no benefits and is basically minimum wage. For other jobs, recruiters either provide no response or say that I am overqualified, refusing to believe that I have difficulty getting into a residency program as an American graduate. Under these circumstances, it’s challenging to raise funds to apply to hundreds of residency programs, while also trying to take care of the everyday costs of living.
At the medical school l attended, about 80 percent of the internal medicine residency program is comprised of non-U.S. citizen graduates from foreign medical schools. It is a large medical center in the middle of a predominantly African-American city, yet the medical trainees are not concerned about the patient population, based on the complaints patients commonly make.
As a rotating third-year student, many patients have expressed excitement in seeing me care for them as a U.S. citizen who is more culturally attuned to their issues. They have numerous times in direct comparison complimented me for offering more empathetic care. In general, the patients have little trust that many of the foreign-trained medical residents care for the health of their patients. Many of these residents spend minimal time in contact with patients, and I have overheard a foreign-schooled physician condescendingly refer to practicing in this predominantly African-American area as doing “veterinary medicine.”
The resident class is so skewed toward foreign medical graduates that U.S. graduates are often the “loners” at academic meetings and clinical rounds. Many foreign medical graduates as senior residents and program directors advocate for other foreign medical residents on admission committees over U.S. graduates. The policies concerning who gets admitted to a program are therefore clearly “lax” and lacking any structure that aligns with the priorities and interests of the United States of America and American citizens whose tax dollars fund residency programs.
American citizens live among the patients they care for and can better relate to the cultural and socio-economic factors impacting their care. Studies have shown that patients fare better when their caregiver is reflective of the population they serve. U.S. graduates also have a massive burden of federal and private student loans that is not shared by foreign medical graduates. No other country has a system whereby it is possible to prioritize other countries’ medical graduates over its own.
This selection system for residents is critically broken and is causing undue suffering to American graduates and, as such, long-term damage to critical U.S. interests. There are thousands of American graduates on the sidelines waiting for residency positions, but they are overlooked in preference for foreign medical graduates.
This problem can be corrected by a system whereby medical residency programs must give priority to U.S. graduates. In particular, a medical residency position should not be filled by a foreign medical graduate if there is a qualified U.S. medical graduate in the applicant pool. This is not radical, anti-immigration solution, it is simply about taking care of American interests first.
One of the most fundamental problems leading to unmatched U.S. graduates is that a U.S. medical education is based on an abridged model where medical students graduate but need to “match” into a residency in order to be a license-eligible independent practitioner. Imagine having a party at your house but allowing the neighbor’s children to eat all the prepared food while your own children starve! These facts concerning this critical capstone phase – especially making it open to the entire world without any sort of explicit prioritization – sets up many U.S. graduates for years – or a lifetime – of misery from lost time, wages and general progress in their lives and careers. It is virtually a career death sentence not to match into a residency.
No other profession in America gives degrees to people who are not license-eligible, and then they have to compete with the world for a chance to finish their training as an independent professional!
We must stop wasting the lives of intelligent, educated American citizens. We must stop stealing physicians from other less developed countries and act responsibly. We must finally take care of our own and put Americans first.
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