Every current fourth-year medical student in the country marked March 17, 2014 and March 21, 2014 on their calendars a long time ago. The first date tells students if they matched into residency and if they will begin their training program this July. The second date tells students where they will ultimately live, breathe and work for the next three to seven years as a member of the hospital’s housestaff.
My personal journey to March 17 was similar to most of my colleagues — I went through medical school enjoying my clinical years while dreading the USMLEs, I debated between internal medicine and pediatrics, and I ultimately interviewed at a dozen places before excitedly submitting my rank list in late February. At that point, I had to trust someone — or something — that March 17 would bring me good news.
March 17 was a vastly more important date for me than March 21, as the only thing more important to me than where I am going to train is if I am even given the opportunity to train in the first place. Let me clarify.
As lawyers finish law school, entrepreneurs finish business school and dental students finish dental school, they are trusted and active members in their line of work. They are productive members of society and their academic effort, as well as the support and resources that were required in the process, will be appreciated by society.
Medical training is different. Upon graduation, medical students must still engage in residency and fellowship training before they can practice medicine independently. Each of the physicians you have every worked with has undergone this additional training before they began taking care of you.
Approximately 7% of American medical student graduates did not receive good news on March 17 and therefore will graduate medical school this May with an MD, but will not continue their career aspirations. This was not because of poor merits or lack of professional behavior. It was simply a numbers game: there are more medical student graduates than there are spots for residency.
The basic problem is that medical school spots are funded by state governments and they have steadily increased over the last 10 years as a response to the anticipated and very accurate physician shortage we are currently experiencing. However, residency spots are funded by the federal government (primarily Medicare) and as a result of the Balanced Budget Act of 1997 (an act attempted to reduce the deficit), residency spots have been frozen since 1997.
In the year 2014, we have to treat an aging and growing (and sicker) population with the same number of physicians from 1997. This leaves society with fewer trained physicians, which will exacerbate the physician shortage and have a deleterious effect on patient care.
In addition to this clear quandary, we must also consider the implication of a surplus of medical students in the system. We are creating a bottleneck and leaving talented, educated and financially-strapped medical school graduates without jobs simply because there are not enough residency spots available.
By now, you must be thinking that this makes no sense. Unfortunately, you are right. Fortunately,you have the power as medical students to create change in your medical education.
Although it is easy blame the government, politics and dollars for problems that I have presented, I am confident that we as medical students must have the loudest voice in order for our desired changes to take place. Besides society, we are the biggest beneficiaries to increased residency spots. Policy leaders can advocate on our behalf, but it is the will and determination that got us into medical school that must be heard. Most of us dreamt of becoming physicians and were confident that our dreams came true the day that we got into medical school. However, that is simply not the case. By the time the Class of 2016 applies to residency, up to 12 percent of students will not match into residency and therefore will not begin the final training necessary to becoming a physician.
I count my blessings that I received good news on Match Day and that I will begin my internal medicine residency training this July. However, for those of who you are reading this and will eventually apply to residency (all of you!), I want to encourage you to get involved in the SaveGME campaign to save graduate medical education for yourselves and future generations of physicians-in-training.