On Saturday, the AOA House of Delegates passed a resolution calling for the profession to advocate for federal legislation to allow U.S. medical school graduates to lay first claims on U.S. residency positions.
Members of the New York State Osteopathic Medical Society (NYSOMS), which submitted the resolution, believe that the nation’s residency positions should first be offered to graduates of U.S. medical schools before international medical graduates (IMGs) can secure them.
“There’s a collision between the numbers of graduates of U.S. medical schools and the limited number of residency positions currently in the U.S.,” says Robert B. Goldberg, DO, the dean of the Touro College of Osteopathic Medicine in New York. “Soon, those positions will be saturated before we count one internationally trained physician vying for one of the slots.”
Steven I. Sherman, DO, the president of NYSOMS, says he wrote the resolution because the numbers of medical students are increasing while U.S. residency positions have remained relatively stagnant.
“These students need to have a place to go when they are finished,” says Dr. Sherman, who is an ophthalmologist in New York City. “It doesn’t seem right to me that students should incur a tremendous financial debt and not have any place to go afterward.”
The mean reported medical education debt among osteopathic medical school graduates was more than $211,000 last year, according to the American Association of Colleges of Osteopathic Medicine.
The number of first-year enrollees to U.S. medical schools increased 30% between 2002 and 2012, The New England Journal of Medicine reported. At roughly the same time, graduate medical education positions grew by just 0.9% each year from 2001 to 2010. U.S. residency positions have remained static because Medicare funds the bulk of them, and Congress capped the number of residency positions nearly two decades ago by passing the Balanced Budget Act of 1997.
IMGs comprised a sizable share of the National Resident Matching Program’s 2014 matches. Of nearly 27,000 positions offered, more than 3,600 non-U.S.-citizen IMGs matched, while more than 2,700 IMGs who are U.S. citizens landed positions, according to The ECFMG Reporter.
Both Dr. Sherman and Dr. Goldberg, a fellow member of NYSOMS, stress that they have nothing against IMGs.
“Some international medical graduates are outstanding,” says Dr. Sherman, a New York delegate. “They are very well-trained. Many of them have done residencies in their own countries, and they come here and they are very fine doctors. But these residency positions are paid for by federal tax dollars, so U.S. citizens should have the first opportunity to fill them.”
Without postgraduate training, new physicians—with the exception of those in Missouri—are unable to practice and will likely struggle to find work and pay off their debt. Reserving GME spots for graduates of U.S. medical schools is one action the profession can take to better ensure residency positions for its graduates, Dr. Goldberg says.
“When we look at these changes in medical education, we realize the importance and value of these GME positions for every one of our graduates,” Dr. Goldberg says. “Our schools grew in size and number in response to a cry from the federal government and others for the profession to expand. Now that we have done that, we believe that the second part of the bargain is for the responsible persons to provide the graduates we produce with the training they need to become successful practicing physicians.”
Correction: This article has been updated to clarify that new physicians need graduate training (residency or internship) to practice. A previous version stated that new physicians couldn’t practice without residency training.