Almost 10% of medical school students each year do not get a hospital residency, leaving thousands without the required training to work as physicians and contributing to a growing shortage of doctors in the U.S., medical education professionals say.
“Ultimately, it’s a huge hit to our health care infrastructure,” said Kevin Lynn, founder of Doctors Without Jobs. “We are desperate for our doctors. And here is a cohort of doctors — thousands that want to practice, that need to practice and cannot.”
Douglas Medina, who graduated from Georgetown University School of Medicine in 2011, hasn’t launched a career as a licensed psychiatrist because he hasn’t been able to secure a hospital residency for the past eight years.
In the meantime, he has been working as a per-diem intake clinician at an addiction treatment center in Las Vegas, where he sets up transfers and evaluates walk-in patients.
“Even working this job, there’s no way I could get out of this debt,” said Mr. Medina, who owes more than $470,000 from student loans. “The only way I can get out of debt is if I work a job as a physician.”
He is among thousands of medical school graduates who do not have a residency this year.
The National Resident Matching Program is a nonprofit that helps match medical school students to hospital training centers across the country based on data provided to it by students.
It says 38,376 students applied for the 35,185 residencies available this year. Only 34,727 of those residencies were filled, said Barry Eisenberg, senior communications analyst for the National Resident Matching Program — leaving 3,649 applicants (9.5%) without a residency.
Meanwhile, the Association of American Medical Colleges says the U.S. is facing a shortage of about 20,000 physicians, including primary care doctors and specialists.
According to the association’s data, the deficit has hit the hardest in the South, which has a shortage of 31,400 physicians. The Midwest has a shortage of 12,900 doctors. The West has enough physicians to fulfill demand, and the Northeast has a surplus of 23,900 physicians.
What’s more, first-year enrollment at U.S. medical schools has increased, the Association of American Medical Colleges said, but the number of residencies has not kept up with the steady growth.
“What we really need to focus on is expanding the number of training positions so that we can actually get people out in the community,” said Dr. Atul Grover, the association’s executive vice president.
Congress has capped the number of Medicare-funded residency training slots for more than two decades, which explains the slow growth in positions each year, the association said. Each hospital was capped in 1997 at the number of residency slots they had at the time.
Sen. Robert Menendez, New Jersey Democrat, introduced in February the Resident Physician Shortage Reduction Act, which would increase the number of federally supported residency positions by 3,000 each year for five years starting in 2021. It also would reserve half of those positions for residents in shortage specialty residency programs.
“With an older physician workforce and an aging population overall, the demand for qualified doctors in New Jersey is quickly outpacing supply,” Mr. Menendez said. “We simply have far too few medical school students and physician residents in the training pipeline in order to catch up. If we’re going to meet the future needs of our residents and ensure access to quality health care, we must close the gap by lifting the arbitrary cap — quickly.”
His legislation has been referred to the Senate Finance Committee and has support from 11 Democrats, two Republicans and one independent.
Rep. Terri A. Sewell, Alabama Democrat, introduced a companion bill to Mr. Menendez’s legislation in March.
According to the National Resident Matching Program, about 1,500 medical school graduates from previous years seek hospital training each year, and about 800 of them fail to match to a residency.
“Those who fail to match usually have something in their backgrounds that leads program directors not to rank them: an academic or professionalism issue. In other cases, the students apply in specialties for which they are not competitive based on their grades and exam scores,” said Mona Signer, the program’s president and CEO.
Mr. Medina acknowledged that he scored lower on his exams, but said he graduated from medical school in good standing.
“Applicants and program directors should rank each other in order of their true preference. In some cases, applicants who are not from U.S. medical schools are better qualified,” Ms. Signer said.
U.S. graduates face competition for residencies from foreign students. Of 32,194 residencies available for first-year, postgraduate medical school students, 4,028 were secured by noncitizens and graduates of foreign medical schools, almost 13%, the data show.
But Dr. Grover said there are enough residencies for all U.S. medical students and even some left over for foreign students.
“It’s not as if those places are being ‘taken up’ by somebody else. I think you want to give programs the flexibility to choose the best and brightest, regardless of where they come from,” he said.
Brewer Eberly Jr., a first-year resident at AnMed Health in Anderson, South Carolina, did not match into a training program immediately after graduating from the University of South Carolina’s medical school in 2018.
He secured his residency in mid-March and said the main reason he didn’t match the first time was because his exam scores weren’t high. Mr. Eberly, who wants to be a family medicine doctor, said family medicine is not a competitive field and is facing a doctor shortage.
“Patients need care,” he said. “And second, the patient population is going to age.
“I think the highest growing patient population will be patients over the age of 60. So you’re going to have this massive blossoming geriatric population with no one to take care of them,” Mr. Eberly said. “It’s pretty terrifying, right?”