Match Day 2024 – We Can Do More to Address the Physician Shortage
Earlier this month college students and sports fans eagerly awaited the release of the NCAA basketball tournament brackets, wondering whether their school made the cut, assessing their regional strength, and betting on this year’s Cinderella.
As much fun as March Madness is, another announcement last weekend is far more important for medical school students: residency match day. That’s right, every March, the National Residency Match Program (NRMP), colloquially called “The Match,” tells fourth-year medical students and doctors from around the world what specialty they’ve been selected to learn and where they’ll be learning it.
Residency is a multi-year practical training program for newly graduated doctors. During this program, aspiring doctors gain practice proficiency under the tutelage of practicing medical professionals.
But unlike most professions, only a handful of doctors get to decide their specialty and where they’ll train. Instead, fourth-year medical students apply to various programs, interview with select schools, and rank out their preference of institutions and specialty to the NRMP—residency programs likewise submit their preferences for residents. After years of training, doctors’ fates come to rest with a computer algorithm that spits out their “match.”
Unfortunately, not every up-and-coming physician gets matched to a program. In 2023 alone, of the nearly 50,000 applicants who submitted their rank lists to the NRMP, roughly 5,000 did not receive a match. But this isn’t an anomaly. Every year, around 10 percent of students who graduate from U.S.-based medical schools and more than 30 percent of students who graduate from foreign medical schools fail to make the bracket. (Some students who fail to match wind up placing in a program through the “SOAP” process in the week or so after the Match, but thousands of medical school graduates are still unmatched after SOAP).
Some students fail to match because they rank the most desirable specialties and the most prestigious or in-demand facilities. Some fail to match because they cannot demonstrate sufficient mastery of the knowledge or skills of doctoring. However, a significant number of students fail to match because there are fewer residency slots than graduating students.
More colleges are opening medical schools to address the nation’s healthcare professional shortage crisis, but those efforts are thwarted if their graduates cannot secure state-mandated residency training to obtain their licenses—making the situation even worse.
The cap on residency slots was caused by a historical accident: In the late 1990s, Congress was told that the U.S. would face a mounting doctor surplus unless the growth in the doctor population was artificially controlled. In response, Congress capped federal subsidies to residency programs at the 1997 levels, and, with only small exceptions, those caps have remained in place despite a decade-long concern about present and future physician shortages. Fortunately, states have some innovative ways to fix the problem. One such solution is smoothing the pathway for more internationally-trained doctors to practice medicine in the U.S.—and it has a secondary benefit.
States can remove mandates for internationally-licensed doctors to repeat residency before practicing in the United States. Not only can this quickly increase physician availability, it also will free up scarce residency slots for graduating U.S. medical students. And unlike many solutions to problems Washington, DC created, this solution is entirely within the power of the states.
Most residency training is redundant for doctors licensed abroad who have already received similar training and have been caring for patients in other countries. States as diverse as Tennessee, Florida, Virginia, Wisconsin, Massachusetts, Arizona, Idaho, Colorado, and Illinois have recognized this and are taking steps to implement reforms.
Generally, the new laws will require a doctor to fulfill every other state licensure requirement except for a U.S.-based residency. They must also work at a sponsoring healthcare facility for their first few years of practice to ensure their quality of care meets strict standards. Some states are requiring practice in rural or underserved communities as well.
Doctors trained outside the United States who complete a residency here and practice in the United States (about 30% of current doctors) disproportionately practice in underserved communities. Waiting lists for medical appointments continue to grow, and rural residents are forced to travel ever farther to see a doctor. Iowa is a prime example of this issue with the fewest OBGYNs per capita out of all 50 states, leaving residents to travel hours within their state to receive care. Increasing the overall supply of physicians will help rural areas and other underserved populations the most.
International physicians are ready to serve American patients, and states should help them “match” up with the people who most need better access to care.
Jonathan Wolfson is the Chief Legal Officer & Policy Director at The Cicero Institute.
