The National Resident Matching Program (NRMP) is a nonprofit, nongovernmental organization created in 1952 to place American medical school students into U.S. teaching hospitals’ residency training programs, which are mostly taxpayer subsidized through Medicare funds. Since its founding, NRMP has expanded its mission to place qualified non-U.S. citizen international medical student graduates (IMGs) into residency and fellowship programs. Although NRMP has helped place many competent foreign-born doctors, the process leaves too many American physicians out in the cold.
In the most recent match, which happened last month, 1,162 U.S. medical school seniors and 811 previous U.S. graduates did not match to a residency at a teaching hospital, so nearly 2,000 U.S. grads did not get residency. Without fulfilling residency requirements, doctors can’t practice medicine.
In last month’s match as well, 4,028 non-U.S. citizen students/IMGs matched and were granted residency, bringing the total number of IMGs placed in U.S. residencies since 2011 to 31,894. The 2019 NRPM results are similar to previous years, with the number of IMGs who match each year increasing.
Although the majority of U.S. citizen doctors match, for the thousands of graduates who have spent many years obtaining their education, it can only be devastating and shocking to realize they cannot work in their chosen profession and are saddled with hundreds of thousands of dollars of student loan debt. For 2016-2017, the average cost of four years of undergraduate education and four years of medical school at a public college, out-of-state, averages more than $300,000.
Institutions that should be doing more to help American doctors achieve their life-long dreams instead work against them. That includes the powerful, influential American Medical Association which has a strong lobbying presence and actively pursues more employment-based visas, namely the H-1B and the J-1 to bring in more foreign-born doctors. Last year, in his letter to USCIS Director Francis Cissna, AMA CEO James L. Madara urged the agency to make more visas available. On its website, the AMA has posted three pages of immigration-related topics including one that advocates for permanent status for deferred action for childhood arrivals (DACA) students in medical school or already working which would represent more job competition for American doctors.
In addition to the U.S. doctors that the current process victimizes are the ill and needy in the IMG’s native countries. A New York Times op-ed referencing the prestigious British medical journal, The Lancet, stated that the practice of luring foreign physicians and nurses to Western countries weakens the health care systems in the home countries and amounts to “poaching” and “an international crime.” Strong words, but at a minimum when the U.S. gives permanent residency to physicians from Third World countries it’s selfishly practicing “brain drain.” When health care specialists leave their home countries, their colleagues have to cope with impossible workloads that may hamper their ability to provide adequate care.
As a result of the AMA’s intensive lobbying, earlier this year the House of Representatives and the Senate reintroduced The Resident Physician Shortage Reduction Act of 2019, previously offered in 2013 and 2017. Ideally, the bill would prioritize hiring U.S. physicians. But in D.C.-speak, shortage means more visas must be issued, bad news for job-seeking American doctors.
The Association of American Medical Colleges, an organization that the AMA often cites to make its case in Congress for more visas, concluded that the nation could have a physician shortage of as many as 120,000 by the end of 2030. But the NRMP results show that American doctors available and eager to move to the next stage of their career following medical school graduation are shut out of practicing medicine.
In 2017, President Trump signed the “Buy American, Hire American” Executive Order. But to jobless U.S. doctors, President Trump’s order is meaningless. American doctors deserve top priority which an overhaul in the NRMP could provide.