Non Traditional Pathways in Healthcare

The fact is, the shortage of Physicians is not due to lack of medical training programs but due to lack of funding from Medicare to offer residencies. Unlike PA or NP routes, MD's and DO's need at least one year of an accredited residency to obtain a license to practice as a general practitioner. Many states require 2 or more years. Since the 1980's the number of applicants has surpassed the number of residency slots.

I believe this year there were over 10,000 Physicians that did not get matched to a residency! Most of these are US citizens that went abroad to foreign countries to study medicine and passed the US license exams (USMLE) but are unable to practice until they complete at least 1+ year(s) of ACGME accredited of residency.
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So making new medical schools is not going to solve the problem! Finding residency funding will!

As a side note, there are some foreign medical schools that advertise PA, DC or NP to MD. Yes you will receive a MD degree but it is unlikely a foreign graduate will obtain a US residency and subsequent licensure when many of our US graduates are struggling to get a residency! However, if your degree is issued by a W.H.O. recognized school then one may be able to get an internship and license in another country.

 

My friends wife went to med school in Dominica or Dominican Republic and she passed the boards here but not with a high enough score to practice. I guess theere is a different standard for US school graduates and foreign graduates?

She found a program that is a "transfer" program from foreign med school graduate (but not practicing) to US NP program.

 

I think the pathways are proposed as a solution, not to the lack of medical programs, but to the lack of people who want to take on the time and debt of medical school. Some states are even looking for ways to shorten medical school by getting rid of duplicate courses that were taken at the undergraduate level to fulfill prerequisites and by making the programs year-round adding summer semesters.

 

The only solution is to add more residencies! A doctor is dead in the water without a residency so other "pathways" are irrelevant!

 

The "standards" are the same for all! The fact is, US medical graduates are favored for residency above foreign medical graduates and rightly so! If a foreign medical graduate (FMG) wants to get, for lack of a better term, a leftover residency, they better have very high scores on the USMLE exams and no repeats! The competition is fierce! That's primarily why I decided not to go to a foreign medical school and go the NP route instead!

 

He told me there was a different standard...perhaps he stretched the truth a bit. She was a US citizen bu had family in Domican Republic - the med school was cheaper and I think her grades did not get her into a US school

 

Officially, the "standard" is the same for passing the exams! In addition, there are never guarantees! 20 years ago she probably wouldn't have had a problem getting a residency with a bare minimum passing score! Today the competition is fierce because there are not enough residencies to cater to all the applicants that have met the "standard"!

She is fortunate that she was able to go on and get her NP license. I know FMG's that are driving taxis and mopping floors trying to pay back the $200,000 in student loans! The reality is that there is no shortage of doctors only a shortage of residencies to train doctors post graduation!

Program directors of medical residency programs have an unwritten priority when selecting applicants. Pehraps it is because they want their graduates to get a residency first!

1. US Medical Graduates MD and DO
2. US citizens that are FMG's
3. Non US Citizens that are FMG's (This route ensures a lot of red tape getting visas so it is not their preferred choice but it was necessary 20 plus years ago).

Other considerations: US clinical rotations, High scores on USMLE and first time passers. Less than 5 years since graduation preferably less than 3! It's just the way it is and applicants for residency are literally a dime a dozen right now! I know this doesn't make sense when the media is constantly blasting statements that there is a shortage of doctors. Like I said the Physician is worthless as a clinician without an accredited residency! Puerto Rico being the exception! They have both ACGME accredited residencies and Puerto Rican accredited residencies. Perhaps you should tell your friend this. The Puerto Rico residencies "internado criollo" pays on average $1 after you finish a year long internship.

 

LECOM also offers a similar, 3-year program to all incoming medical students who agree to practice in Family Medicine or Internal Medicine for 5 years post medical school and residency. It's called the Primary Care Scholars Pathway.

 

Unless they've changed things recently, LECOM does not offer the PCSP to all incoming medical students who agree to practice in FM or IM, etc.

A prospective PCSP student would be admitted to and start in a 4-year pathway, then within their first year would have to apply and compete for a spot in the PCSP. Initially there were 6 spots in the PCSP pathway per year. For the 2009 entering class, there were 10 spots. 30 students competed. For the next year the number of spots was increased to 12. It appears that only a small number of LECOM Erie students even who would agree to the stipulations can take this pathway.

So the APAP PA-to-DO pathway has the advantage of selection for the 3-year pathway being built into admission to the school, rather than a later competition the student might or might not win. Of course, there are currently only 12 slots for the APAP pathway. Admission to the APAP would surely be very competitive too.

More on the PCSP: Reviving interest in primary care (Carolyn Schierhorn, The DO, August 3, 2009).

 

On the subject of shorter med school calendars, though, McMaster and Calgary in Canada offer their entire regular MD program within 3 years. NYU is now introducing a Three Year MD for students who, and this is something different, are accepted into an NYU residency at the same time they're admitted into medical school. Clinical training schedules are adjusted, and concentrated in the department where the student is set to go on to a residency.

A related issue is length of residency training. Family medicine residencies in Canada are two years in length. The American Board of Family Medicine basically recognizes a two-year Canadian FM residency as equivalent to a three-year American FM residency. (Notes: Canadian medical school admission is much more competitive, and Canadian FM residency selection is likely more competitive. After their two year residency, many Canadian FPs add an optional third year in a training fellowship.)

 

A lot of people go to foreign medical schools because they can't get into American schools in the first place.

 

Exactly! Nowadays it is particularly a risky investment because one may not get a residency! Then what do you do with a foreign diploma and $240k in student loans?

 

I note a few threads on other boards like this one on valuemd.com, a webboard on international medical schools: "Jobs for MDs w/o license..." Option 1: adjunct faculty! Down further, though not much: Remember the Rutgers Skill Certification Center, which awarded pdf Skill Certificates online for $25 before inevitably closing down? A poster suggests getting a Medical Assistant certificate there. (The thread is a few years old.)

Seriously, there seem to be a few interesting less traditional health-care career paths noted there, though. Excelsior nursing; the limited-scope radiologic technician thing. Orthopedic Physician Assistant. Bone Densitometrist.

 

Hey, whatever works! Might be a good option for Foreign Medical Graduates (FMG's) to keep their head above water while trying to get a residency but unfortunately, these Allied Health Care professions don't put much of a dent into a 6 digit student loan! In other words, I feel sorry for many of those who went down the foreign medical school track and didn't get a residency. As for me, I am glad I chose to stay in the USA and go another pathway.

 

You go to work for a pharmaceutical company (especially viable if the foreign diploma holder has or obtains an MPH). Of course this option wouldn't work for everyone in this position, but I work for a very large pharma company and there are a number of foreign MDs here who have never practiced in the states and do not hold a medical license and yet hold very lucrative positions.

 

The US residency match graph showed about 10,000 Physicians not getting matched this year into a residency program. That doesn't include the thousands that stop applying because they graduated greater than 10 years ago! Are there 10,000 plus job openings in Pharmaceutical research? That sounds like a great option!

All I am saying is that I would be careful about attending a foreign medical school with the intention of returning to the USA and obtaining a US residency position while there is a lack of funding.

"Residency Training and International Medical Graduates Coming to America No More":
http://jama.jamanetwork.com/article.aspx?articleid=1475200

Correction, they call them International Medical graduate (IMG) versus FMG.

 

I think the problem with IMGs is simply getting the residencies needed to lead to licensure in the US. If the US funded more graduate medical education programs, we'd have less of a physician shortage. Conversely, this is easier said than done. My personal opinion is IMGs should be open to the route mentioned by japhy4529, and I thank him and everyone else on the board for mentioning alternatives! As a huge fan of alternative and distance education, I get energized reading this forum!

 

A new feature to the Accelerated Physician Assistant Pathway at LECOM: For certified PAs, they've waived the MCAT requirement,

Accelerated PA to DO Program Waives MCATs (Juliet Farmer, Student Doctor Network, January 16, 2014)