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This is one in a series of occasional updates on the lives of people featured by STAT during our first year.

They have MDs to their names, but they can’t treat patients. Now Dr. Heidi Schmidt — and others like her — are heading to nursing school to fulfill the dreams that were quashed when they failed to match with a residency program after medical school.

Schmidt, who’s 47, is one of thousands who have graduated from medical school yet failed to match with a residency, the post-graduate training doctors need in order to practice medicine in the United States. STAT wrote about her in March, when more than 29,000 applicants matched to a residency but 8,640 applicants failed to get an offer through the main matching process. This number includes hundreds of students in their final year at US medical schools, as well as foreign nationals and US citizens from international medical schools.

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Many failed applicants reapply after spending a year doing research or a fifth year in medical school. Others join the “Dropout Club,” a group for doctors and scientists who leave their intended professions for alternate paths.

Though they have medical degrees, doctors who don’t do residencies can’t treat patients, or even work as nurses or medical assistants, without further training. Some in the medical profession say that’s a good thing, because there’s a reason — such as poor performance on board exams — that these new MDs didn’t make the cut. But others call it an outrage that doctors’ skills are going to waste amid a shortage of primary care physicians, just because there aren’t enough residency spots to go around.

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Schmidt, who graduated from American University of the Caribbean School of Medicine in 2010, had been hoping to take advantage of a 2014 Missouri law that will allow unmatched medical school graduates to work with a collaborating physician in medically underserved areas. But implementation has dragged: The Missouri Board of Registration for the Healing Arts doesn’t anticipate accepting applications until early 2017, according to a spokesman.

Kansas and Arkansas have passed similar laws — over the objection of groups such as the Association of American Medical Colleges, which contends that it’s not safe to let doctors bypass the traditional residency, which lasts at least three years. Kansas, whose special permits are restricted to graduates of the University of Kansas School of Medicine, has not had any takers so far. Arkansas, which limits applicants to those with ties to the state, just issued its first two special permits in October.

Schmidt isn’t waiting around. She is back studying chemistry 101 and human anatomy, as she begins a three-year journey to become a nurse practitioner. She has been accepted into a bachelor’s of nursing program in Indianapolis, where she lives, and plans to use loans and scholarships to pay the approximately $140,000 in total costs.

Volunteering in a free medical clinic in Indianapolis has rekindled her passion to practice medicine, she said.

But Schmidt said she’s frustrated that there isn’t a faster — and less costly — track from an MD to a master’s in nursing.

“My schedule is insane,” she said. “I stay up half the night taking online classes.”

  • WOW! I can’t imagine how much debt she must be in. The stigma against DO’s is all but gone now; I don’t understand why people who don’t make it into traditionally allopathic schools can’t just go to osteopathic schools? Having an MD behind your name is that important? I’m glad I didn’t decide to go into medicine for a title, that’s for sure.

    • Think about it this way. You can’t get an MD to work in a Federal Prison. The pay sucks but if they hire this gal she should do so in return for 100% forbearance on all her loans, which they would do in a heartbeat.

  • This is why for-profit medical schools in the caribbean need to be shut down. The majority of students who go there could not get into US medical schools for a reason. I know a few people who went (one for that reason, one b/c his wife couldn’t). I have heard awful things about these schools. They only care about $$ and offer no assistance to their students. They lie about their match statistics and poor students, who desire to be MDs, don’t realize they are taking on tons of debt with a low chance of actually matching. The fact that she went to a caribbean school, graduated 6 years ago and hasn’t matched and is now taking on the debt to go back to school for 3 years for NP makes me question how qualified she really is. That being said if she ends up practicing as an NP it would be highly unethical for her to practice using her “Dr.” title.

    • As a FMG who is currently in a highly sought after residency position, I disagree wholeheartedly with this statement. There are a lot of factors that prevent some highly qualified students from getting into US medical schools. Being a middle class white american being the highest on that list. I worked day in and day out to get where I am, and a US medical school wouldn’t give me that opportunity, but AUC did. There are many students who go to Caribbean medical schools that should not be in medical school, agreed, but there are several (likely treating you or you family members) that did and are damn good at their job.

  • Hey Biff, you’re an idiot. I didn’t go to medical school because I was busy raising a family and serving my country. I went to nursing school to support same.

  • I don’t care if FMGs have “better scores” than many americans, they studied abroad, they should practice abroad. These are american spots being yoinked by internationals who come here, take the spots, train in our residencies, and go back to their countries. Not only that, but they may have good scores, but that doesn’t make a good physician. They are books only.

    • Agree but a growing number of international medical students are Americans who are left without seats back home due to foreign applicants pretending to be american.

    • Ahhh a good amount of foreign Med grads are Americans who went to a foreign medical school. They shouldn’t be allowed to come back “home” to train and work?

    • “American” spots? Seriously? Why should US medicine be some kind of affirmative action for underperforming US citizens? How about “if you can’t pass your exams, YOU go practice abroad?”

      As a patient, I’d far rather be treated by a competent foreign trained MD than the dregs of a US DO program who made multiple attempts on their USMLE.

  • Tough decision, but the most important factor at least for foreign medical graduates is the USMLE scores. Local graduates require just a pass to get into a residency program as their acceptance into a residency program is weighted by strong recommendation letters by physicians training them. Additionally getting into a US medical college is not easy. However, much of the foreign medical graduates training is unknown to the US residency programs and they have to rely on USMLE scores. I would believe an FMG to get accepted into a residency program, the average of all three steps to be above 80 (or the 50th percentile). That would also mean that the FMG’s medical and clinical knowledge is above the 50th percentile of US medical students and gives reasonable confidence for residency programs to offer a position for the FMG. If anything the US residency system and USMLE at least offers a fair system under which anyone from any part of the world can come into US to realize their aspirations to practice as a physician in an environment that is not found anywhere else. But first they need to qualify themselves first. That said USMLE is not a trick exam, the scores reflect how well the examinee has prepared. If you can get into a medical school getting to the 50th percentile in USMLE is just a matter of studying hard

  • Nurses are care givers, they do not treat which doctors do. Her failure and her choice is as contraversial as the healthcare in US; highest in cost and bottom bottom in quality amongest G7 countries. If doctors have become cash cows under protection of Medical Associations – one, that the government cannot touch and a problem of its own creation, is the single most and why patients will not not be able to afford treatment to fall back on the public money that they themselves provide to maintain/provide for a system. The answer to healthcare is opening a flood gate for doctors from fully approved/accredited doctors who already have done residency from other countries which alone will bring in competition to cut cost and bring quality. Is this not free market economy? In absence, no wonder the drug companies will keep filling the gap with very other wonder drugs with impossible prices while their long term effect remains obscured till become known. Worst, treatment is going to move outside as far more economical- the travel healthcare. The is time for consumer care, the patient, who know their problems and will buy the best. This single nurse/doctor case is only a symptom of a much large problem, if single most for the new administration just as an economic one. In in fact all over the west. The poorer East will live, because both the doctors and the patients expect less…….

    • Hello. Nurse Practitioners diagnose and treat. The minimum requirement is a Masters Degree at this time.

    • You have no idea what you’re talking about. Medicine is not expensive because of money grubbing physicians. In fact, payment is strongly dictated by the insurance companies and there are laws in place so that physicians can’t compare reimbursement rates. The real problem lies in the insurance companies having reimbursement dependent on patient satisfaction making doctors order needless studies to keep their patients “happy” and in our litigious society that forces physicians to practice defensive medicine. No one goes into medicine anymore for the income. Half of general practitioners can hardly pay off their med school debt without practicing in physician shortage areas to obtain debt relief.

  • She makes it sound like there was a conspiracy against her. Obviously she did not qualify or she would not have to repeat chemistry 101 or human anatomy …prerequisites for RN , . We need more nurse practitioners as well as physicians to meet needs of aging population…An RN or APRN are not individuals who did not have ability to be MD, they chose nursing ,a more holistic profession to practice in..I am a 40+ year RN

    • The writer used Chem 101 and human anatomy as examples. I seriously doubt she has to repeat those courses. Poor choice of words by the writer.

    • Most likely the school will not accept pre-requisites older than “x” number of years, so she has to retake them.

    • She may have had to repeat due to the fact that the majority of nursing programs require the sciences to be taken within 5 years.

    • Those requirements for Chemistry and Anatomy courses need to be within the previous 5 years for the vast majority of nursing programs.

    • Yeah and I chose to work at Walmart when I could have cured cancer.

      Ever heard of a Nursing school reject being accepted to an American medical school (MD program)? Didn’t think so. Because the bar set to get into nursing school is set waaaaay lower than medical school. I can get my NP degree online in 3 years after highschool and practice independently shortly thereafter.

    • Lol, she really does. Let’s see–got a music degree, decided to go into medicine relatively late in life for med school, was rejected by American med schools ‘because she does not test well’ (test scores don’t mean everything, but they do mean something!), thought it was smart to go to a Carribean school, even though it is KNOWN that is a bad idea!, screwed the USMLE (‘I test poorly!).

      Lady, this is more about your shit life choices than anything else.

      As for finances–she is fine. She ‘comes from a family of doctors.’ I suspect that she is a broke girl with a loaded family. Poor on paper. That sort of thing.

  • There is more to being a good dr than GPA. It isn’t clear why she did match. Nursing is a highly honorable profession, however I question if she should consider training or try rematching at more internships. Consider the military or other ways to make the most of her training without going broke.

  • $140k for a 3 year BSN-MSN program? No wonder she didn’t match because she’s an idiot for spending that much on a nursing degree. Got both my BSN and MSN for a fraction of that cost. Maybe she needs to take a personal finance class as well.

    • David, that is rude. The program likely includes the MSN/NP component a minimum of 4-5 yrs of schooling.

  • Wow. Is she entitled to a residency? No. There is no conspiracy to matching. If you are smart enough, you will match. There are many slots throughout the nation that go unfilled! The reason you don’t or can’t match is simply you are not qualified. Make no mistake, Carribean medical schools are easy to get into, and the overall quality of the student is marginal. I do know some who have been excellent and have matched into residencies in the US and have flourished. I have been a surgeon for 25 years, and I know many excellent physicians. I, also, know many stupid physicians. I tell family practice residents, whom I have the opportunity to train, ” Don’t be stupid doctors.” Stupid doctors are dangerous. America, you want the best and the brightest. The physicians pay IS DROPPING! For the person who blamed physicians for their earnings, well, you’re an idiot. Plain and simple. Sorry, maybe it’ s the last 24 hours of call I have spent operating, mostly for free. For the MD who can’t get a residency, sorry, be smarter, and to think it is easy just to be a nurse practictioner, HA! That takes not only dedication, but intelligence. You still have to make the grade. I would not publish my failures blaming everyone else.

    • You realize that medical schools have increased enrollment while residency slots haven’t kept pace? Or is it that over 8,000 students a year are just not smart enough for you? I imagine that this was not the case when you did your residency. This problem belongs to the AMA for having convinced the government to limit the number of residency positions back in the mid-nineties. We are just reaping what you and other members of the AMA sowed back then. These people aren’t failing, the system is.

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