Facing a Physician Shortage, Can We Leave Medical School Grads on the
Sidelines?
Saturday, 20 February 2016 00:00 By Richard Gunderman, The Conversation |
Report
Dr. Heidi Schmidt cannot practice medicine. The problem is not that she lost
her license or was named in too many malpractice lawsuits. To the contrary,
she has never held a license to practice medicine. Yet she has earned not
only an M.D. but also master's degrees in public health and pharmacy, passed
all the licensing exams required of medical students and devoted countless
hours of voluntary service to underserved populations.
And she is not alone - many medical school graduates like her cannot obtain
a license. Last year, 52,860 U.S. and international medical graduates
applied for residency positions in the U.S., yet only 26,252 actually
matched into a program.
The painful irony is that the U.S. now faces a substantial shortage of
physicians, which is on track to worsen in the decades to come. Increased
demand for physicians is driven by advances in medical science and
technology, population growth and an aging population that uses more medical
care. A study by the Association of American Medical College predicts that
by 2025, the U.S. will face a shortfall of between 46,000 and 90,000
physicians.
The situation is growing worse by the year, because U.S. medical schools
have increased enrollments by nearly 30 percent in recent years, while the
number of residency positions has increased to a much smaller degree.
Facing a physician shortage, can the U.S. leave so many doctors on the
sidelines? To understand how this situation arose, it helps to know more of
Heidi's story.
From Music to Medicine
Now based in Indianapolis, Heidi grew up in a family of physicians. Her
father, brother, aunt and several of her cousins are M.D.'s. But it was
apparent at a young age that Heidi was musically gifted, and when she
graduated from high school, she studied violin and voice at two of the
nation's top music schools. After graduating, she traveled to Italy to study
with one of the world's top voice coaches before embarking on a successful
international career as a voice artist.
She also devoted considerable time and energy to service. She staged a
series of concerts to raise funds to preserve New York City's Central Park
band shell, founded an organization in Italy to support underrepresented
artists, and cofounded a nonprofit organization that provides tutoring and
mentorship to disadvantaged children.
I know Heidi, and she is a talented person who cares about those in need and
gets things done. She is not, however, a gifted standardized test taker.
Taking multiple-choice tests and taking care of patients may be as different
as night and day, but such exams play a huge role in determining which
graduating medical students gain admission to residency training. This
creates problems for poor test-takers, no matter how well they care for
patients.
When Heidi was in her 30's, she decided to switch from music to medicine.
Initially, she did poorly on the medical school admission test and was
placed on the wait list. Feeling the pressure of time, she decided to attend
a Caribbean medical school. She did well in her course work, but again had
difficulty passing the board exam. Eventually, she enrolled in an exam
preparation course that taught her an approach to multiple-choice questions.
Her score went from just below passing to the student average.
Thinking the problem was solved, she was surprised to discover that her
history of exam retakes made residency programs reluctant to "take a chance
on her." If a program accepts a student who performs poorly on the third
step of the licensure exam (which is taken during residency training), its
funding can be jeopardized. And without at least a year of residency
training after medical school, Heidi cannot obtain a license to practice
medicine.
Test Scores Aren't Everything
Exam scores are not the only thing residency programs look at, but they
often serve as a first filter. Many graduates with low scores are eliminated
before their dossiers get a full look. Yet test scores and the ability to
care well for patients are not the same thing, and patients are missing out
on the contributions of many talented doctors.
For students like Heidi, the consequences of not obtaining a residency spot
can be disastrous. For one thing, the average graduate has accumulated an
educational debt of US$180,000. Without a license to practice medicine, a
debt of this magnitude can be nearly impossible to repay. Add to this the
disappointment of being unable to care for patients - a lifelong dream for
many - and the predicament grows even worse.
Yet these figures do not do full justice to the problem, in part because the
distribution of physicians across the country is so uneven, leaving many
communities without care.
Large metropolitan areas tend to be well-supplied, but smaller rural
counties often experience great difficulty recruiting physicians, perhaps in
part because they differ so much from the urban environments of most medical
schools and residency programs.
The irony is this: such underserved areas are exactly where Heidi and many
other unlicensed physicians express enthusiasm for practicing. "I want to
work with patients that other physicians typically do not want to serve,"
she told me. "For example, if I were licensed, I would move to a sparsely
populated rural area and work there for decades, meeting the needs of people
who otherwise would not have access to care. I am not in this for the money.
I want to help people in need."
Asked what she would do to change the situation, Heidi suggests a new
training program that would allow her and thousands of other unlicensed
M.D.'s to train in underserved areas under licensed physicians.
What we are asking for is not a free pass but a chance to prove ourselves.
If we could earn our licenses caring for people who currently cannot find a
physician, we could make a huge difference, and many of us would commit to
continuing to serve needy populations for years to come.
Heidi has been doing this sort of work already, volunteering in a local free
clinic for underserved patients. She sees patients, diagnoses their
conditions and prescribes medications and other therapies just like other
doctors, except that her orders are cosigned by a licensed physician. "Why
shouldn't this kind of work count toward licensure?" she asks. "The
physicians who supervise me would happily attest to the fact that I am
competent to practice."
Despite the challenges, Heidi sees cause for hope.
For example, Missouri is experimenting with an assistant physician licensure
program, endorsed by the Missouri State Medical Association, which would
allow M.D'.s like Heidi to gain supervised experience and qualify for
licensure. Part of the rationale for such programs is to help ease physician
shortages.
Others states, including Arkansas, Kansas and Oklahoma, are looking to
follow suit. Heidi believes they are headed in the right direction. "Many of
us share a deep sense of calling to care for patients," she says. "Given the
worsening physician shortage, how can the nation afford to keep us on the
sidelines?"
This piece was reprinted by Truthout with permission or license. It may not
be reproduced in any form without permission or license from the source.
RICHARD GUNDERMAN
Richard Gunderman is Chancellor's Professor of Radiology, Pediatrics,
Medical Education, Philosophy, Liberal Arts, Philanthropy, and Medical
Humanities and Health Studies at Indiana University.
He received his AB Summa Cum Laude from Wabash College, MD and PhD
(Committee on Social Thought) with Honors from the University of Chicago,
and MPH from Indiana University.
He is an nine-time recipient of the Indiana University Trustees Teaching
Award, and received the 2012 Robert Glaser Award, the highest teaching award
of the Association of American Medical Colleges.
He is the author of nearly 500 scholarly articles and has published eight
books. More importantly, his students are widely published and have gone on
to win many awards and achieve professional distinction.
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Facing a Physician Shortage, Can We Leave Medical School Grads on the
Sidelines?
Saturday, 20 February 2016 00:00 By Richard Gunderman, The Conversation |
Report
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. Dr. Heidi Schmidt cannot practice medicine. The problem is not that
she lost her license or was named in too many malpractice lawsuits. To the
contrary, she has never held a license to practice medicine. Yet she has
earned not only an M.D. but also master's degrees in public health and
pharmacy, passed all the licensing exams required of medical students and
devoted countless hours of voluntary service to underserved populations.
. And she is not alone - many medical school graduates like her cannot
obtain a license. Last year, 52,860 U.S. and international medical graduates
applied for residency positions in the U.S., yet only 26,252 actually
matched into a program.
The painful irony is that the U.S. now faces a substantial shortage of
physicians, which is on track to worsen in the decades to come. Increased
demand for physicians is driven by advances in medical science and
technology, population growth and an aging population that uses more medical
care. A study by the Association of American Medical College predicts that
by 2025, the U.S. will face a shortfall of between 46,000 and 90,000
physicians.
The situation is growing worse by the year, because U.S. medical schools
have increased enrollments by nearly 30 percent in recent years, while the
number of residency positions has increased to a much smaller degree.
Facing a physician shortage, can the U.S. leave so many doctors on the
sidelines? To understand how this situation arose, it helps to know more of
Heidi's story.
From Music to Medicine
Now based in Indianapolis, Heidi grew up in a family of physicians. Her
father, brother, aunt and several of her cousins are M.D.'s. But it was
apparent at a young age that Heidi was musically gifted, and when she
graduated from high school, she studied violin and voice at two of the
nation's top music schools. After graduating, she traveled to Italy to study
with one of the world's top voice coaches before embarking on a successful
international career as a voice artist.
She also devoted considerable time and energy to service. She staged a
series of concerts to raise funds to preserve New York City's Central Park
band shell, founded an organization in Italy to support underrepresented
artists, and cofounded a nonprofit organization that provides tutoring and
mentorship to disadvantaged children.
I know Heidi, and she is a talented person who cares about those in need and
gets things done. She is not, however, a gifted standardized test taker.
Taking multiple-choice tests and taking care of patients may be as different
as night and day, but such exams play a huge role in determining which
graduating medical students gain admission to residency training. This
creates problems for poor test-takers, no matter how well they care for
patients.
When Heidi was in her 30's, she decided to switch from music to medicine.
Initially, she did poorly on the medical school admission test and was
placed on the wait list. Feeling the pressure of time, she decided to attend
a Caribbean medical school. She did well in her course work, but again had
difficulty passing the board exam. Eventually, she enrolled in an exam
preparation course that taught her an approach to multiple-choice questions.
Her score went from just below passing to the student average.
Thinking the problem was solved, she was surprised to discover that her
history of exam retakes made residency programs reluctant to "take a chance
on her." If a program accepts a student who performs poorly on the third
step of the licensure exam (which is taken during residency training), its
funding can be jeopardized. And without at least a year of residency
training after medical school, Heidi cannot obtain a license to practice
medicine.
Test Scores Aren't Everything
Exam scores are not the only thing residency programs look at, but they
often serve as a first filter. Many graduates with low scores are eliminated
before their dossiers get a full look. Yet test scores and the ability to
care well for patients are not the same thing, and patients are missing out
on the contributions of many talented doctors.
For students like Heidi, the consequences of not obtaining a residency spot
can be disastrous. For one thing, the average graduate has accumulated an
educational debt of US$180,000. Without a license to practice medicine, a
debt of this magnitude can be nearly impossible to repay. Add to this the
disappointment of being unable to care for patients - a lifelong dream for
many - and the predicament grows even worse.
Yet these figures do not do full justice to the problem, in part because the
distribution of physicians across the country is so uneven, leaving many
communities without care.
Large metropolitan areas tend to be well-supplied, but smaller rural
counties often experience great difficulty recruiting physicians, perhaps in
part because they differ so much from the urban environments of most medical
schools and residency programs.
The irony is this: such underserved areas are exactly where Heidi and many
other unlicensed physicians express enthusiasm for practicing. "I want to
work with patients that other physicians typically do not want to serve,"
she told me. "For example, if I were licensed, I would move to a sparsely
populated rural area and work there for decades, meeting the needs of people
who otherwise would not have access to care. I am not in this for the money.
I want to help people in need."
Asked what she would do to change the situation, Heidi suggests a new
training program that would allow her and thousands of other unlicensed
M.D.'s to train in underserved areas under licensed physicians.
What we are asking for is not a free pass but a chance to prove ourselves.
If we could earn our licenses caring for people who currently cannot find a
physician, we could make a huge difference, and many of us would commit to
continuing to serve needy populations for years to come.
Heidi has been doing this sort of work already, volunteering in a local free
clinic for underserved patients. She sees patients, diagnoses their
conditions and prescribes medications and other therapies just like other
doctors, except that her orders are cosigned by a licensed physician. "Why
shouldn't this kind of work count toward licensure?" she asks. "The
physicians who supervise me would happily attest to the fact that I am
competent to practice."
Despite the challenges, Heidi sees cause for hope.
For example, Missouri is experimenting with an assistant physician licensure
program, endorsed by the Missouri State Medical Association, which would
allow M.D'.s like Heidi to gain supervised experience and qualify for
licensure. Part of the rationale for such programs is to help ease physician
shortages.
Others states, including Arkansas, Kansas and Oklahoma, are looking to
follow suit. Heidi believes they are headed in the right direction. "Many of
us share a deep sense of calling to care for patients," she says. "Given the
worsening physician shortage, how can the nation afford to keep us on the
sidelines?"
This piece was reprinted by Truthout with permission or license. It may not
be reproduced in any form without permission or license from the source.
Richard Gunderman
Richard Gunderman is Chancellor's Professor of Radiology, Pediatrics,
Medical Education, Philosophy, Liberal Arts, Philanthropy, and Medical
Humanities and Health Studies at Indiana University.
He received his AB Summa Cum Laude from Wabash College, MD and PhD
(Committee on Social Thought) with Honors from the University of Chicago,
and MPH from Indiana University.
He is an nine-time recipient of the Indiana University Trustees Teaching
Award, and received the 2012 Robert Glaser Award, the highest teaching award
of the Association of American Medical Colleges.
He is the author of nearly 500 scholarly articles and has published eight
books. More importantly, his students are widely published and have gone on
to win many awards and achieve professional distinction.
Related Stories
Doctor Malpractice Data Is Removed From Public Access by HHS
By Alan Bavley, McClatchy Newspapers | ReportPhysicians in Congress
Committing Malpractice on Millions
By Brian Moench, Truthout | News Analysis
Show Comments
