Shown on the floor of the AOA House of Delegates, Robert B. Goldberg, DO, supports giving U.S. medical school graduates the first crack at residencies.
Robert B. Goldberg, DO
First Dibs

House supports offering residency positions to US med school grads first

“These residency positions are paid for by federal tax dollars, so U.S. citizens should have the first opportunity to fill them,” says Steven Sherman, DO.

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.


  1. I totally agree with this resolution. I believe American graduates are trained to serve the U.S population rather than someone was trained somewhere in Asia or Africa. Someone would says “medicine or science doesn’t change”. It is correct but do not forget the initial purpose of training physician in EVERY COUNTRY is to serve their own citizen in term of culture, language, beliefs, special health conditions.

  2. In the NRMP match, the rules were recently changed so that pre-match offers are no longer allowed. Even if this were to go through, there are still programs that prefer IMG/FMGs to DO’s. I’m afraid these programs would probably just configure their rank list in such a way that if they didn’t fill with their preferred AMGs, they would just pick up IMG/FMG’s in the SOAP (scramble).

  3. I am in total agreement with this proposal. We are increasing the number of osteopathic medical students at a rapid pace. I four years we will have a large number of new grads with debts to pay off. These new docs need to be given first choice for residency slots over FMGs. Our country should not be draining qualified physicians from foreign countries who have shortages of physicians themselves.


  5. How quickly the DO profession forgets it’s history. What about the days when DOs were on the outside looking in? Now we (think) we have some leverage and we want to shut out FMG. Granted, FMGs as a whole are not as qualified for residency spots but there are some all-stars out there. That decision should be left up to the individual residency director. So instead of doing the right thing and creating more residency spots for grads at a time when DO schools are rapidly enroll ing more and building more schools- we whine and stop our feet when students can’t find residency spots. Let’s open it all up- the best person competes for the best spot no matter if you are MD, DO, FMG or not. Let’s stop casting stones here

    Stephen Carroll, DO

  6. So this proposed change in acceptance would limit the selection of residents to give priority to all med school students who are US citizens regardless of whether they went to a US medical school or a Caribbean medical school so long as they are tax paying US citizens, correct ?

    1. I was wondering the same thing. For example, I am a US citizen and attend a forgien Carribbean medical school using US federal student loans. So, does this proposed legislation include the US students attending Carribbean schools with US federal student loans?

      This article stated “US citizens should fill spots first” and then “US medical school graduates should fill spots first” …they are different

  7. Some Physicians (including me) have practiced primary care in the military for years (7 for me). The reason: Son got sick and had to put my dreams on hold [no one seems to want to take the time to ask me this however]. I have pubs [6 in all] and an awesome reputation among my colleagues and still am having trouble finding a residency. I get over 200 CME’s per year as well so I have made great use of my time as a Physician with no residency cert. I would put my clinical acumen up against anybodies with a similar amount of primary care time [and so would many of my colleagues]. I completed an internship in Neuro (Army matched me here after I did not obtain a spot in Rads). I am not the only one with these issues. We should make certain that American med school grads are getting spots before IMG’s get any sort of shot.

  8. CMS does not pay full freight on residency positions in the US. Many academic centers are well above the CMS “cap” meaning that they receive no salary and benefit support for a number (sometimes many) of their trainees.

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