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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.”

  • This is a sad fact of American Healthcare. If a medical graduate after more than 4 years of medical school cannot be considered safe to treat patients under supervision, then Physicians Assistants (PAs) with only two years of training can be definitely considered extremely dangerous. However, American medicine runs more on dollars than on patient care. Simply absurd and unacceptable.

    • Thanks for the news.
      Also, in my comment about US IMG’s to have preference in residency positions over foreign IMG’s, I should add that AMG’s that did not match, should be given PRIORITY overall.
      Thanks again

  • Have you considered the Puerto Rico “internado” internships as well as reapplying for the match and putting in applications for FNP programs? Here is a link to a blog of someone that has matched to one of these internado interships in Puerto Rico after reapplying to the match multiple times. Just another option to consider (if you haven’t already). I wish you the best of

    • Don’t go to Puerto Rico! Politics and Economy is Terrible!!! I live here and am struggling to get out, it’s bullshit here , even worse than the us. You have been warned!!! There is a reason they are looking for Dr’s, No one wants to work here. Healthcare is a joke here.

  • This article is click-bait. There are no details regarding Dr. Schmidt. What were her USMLE scores? Does she have all 3 of her USMLE steps completed? What residencies has she applied for? If she is trying to get into an ultra competitive residency with a mediocre CV she’s dead in the water. How many residencies has she applied for? Most candidates, especially FMGs, will shot gun approach applying for residency and will pick 10 – 20 programs in a less competitive program across many states to increase their chances. Is she ECFMG (Educational Comission For Foreign Medical Graduates) certified? Does she have a criminal background? Does she have a substance abuse background? Does she have anything in her medical background or psychiatric background that could be problematic? Did she do any externships in the US while in medical school, if so, how was she evaluated in those externships? What kind of LORs (letters of recommendation) does id she have? How dedicated is she to being a physician? Did she ever consider working outside of the US? Has she shadowed a US physician during the time she has been looking for residency?

    I have other questions and could potentially help this person if I knew more about her and her situation.

    • Dear Dr Martin,
      As a common denominator for US IMG’s to enter residency I propose ONLY: ECFMG CERTIFICATION, STEP 3 passed and applying for PRIMARY CARE. Of course-goes without saying- past felonies, mental health, addictions, etc.

      But Scores? Attempts? It should not matter. Studies have proven that the most common causes of medical students to fail licensing test are: 1) poor reading skills and 2) poor test taking strategies. Not lack of knowledge. Did all your successful colleagues nailed the boards with high score and on the first attemp?

      Furthermore another study showed that: “USMLE STEP 1 performance is just one of many variables that may predict success during third year clerkship sand postgraduate training. However, whether it is predictive of PERFORMANCE IN THE LONG TERM PRACTICE OF MEDICINE IS NOT KNOW”
      (Study of Selected Outcomes of Medical Students Who Fail USMLE Step 1. By Biskoving DM et al. Med Educ Online 2006; 11:11) available at http://www.med-ed-online.org

      We should not worry about future performance of these docs that failed to pass their licensing exams in the first attempt/ or obtained a lower score, WE SHOULD NOT JUDGE a “priori”. Once they are licensed, any complaints / lawsuits for under standard of their practice or faulty ethics, it’s a bridge far from here and the sole responsibility of State Medical Boards. All the best

    • Agree completely – we are not getting the whole story. Perhaps she has passed all steps of USMLE on her first attempt, perhaps she has great letters of recommendation from her clinical rotations, perhaps she has no problems in her background, perhaps she interviews well, perhaps she applied for multiple primary care residencies in unsexy parts of the country – but somehow I think there is something else going on which explains her unfortunate predicament. Sadly, I have seen some international medical students who perform so poorly on their exams that is apparent that they will not succeed, but they insist on persevering against all advice, taking exams time and time again until they scrape by (or not), and then blame the fact that they are an international student for their failure.

  • The poor quality of medicine I see practiced in the rural county I now live in will be continued by the addition of more unqualified people like this who after being weeded out get a midlevel degree and get hired. There are many NPs and DOs where I live and I am shocked at how bad the standard of care is – in other words what standard of care. People like this young woman should be steered in another direction. Clearly this is not her calling.

    • My uncle is ENT that is DO and I am a MD. He is one the top physicians in the state and one the top ENT practices in the country. His benchmark scores for HEDIS and medicare were better then ENT’s that were trained in the John Hopkins and Harvard. He is the go to surgeon also for thyriodectomy, para or traches etc over our general surgeon that is MD. ALL the dermatologist send him patients for facial removal of skin cancers!!!

  • I can understand the frustration; just being accepted to medical school is a bit of a fiddle. However, MS Schmidt you have climbed the highest mountain, why quit now? You only need an internship to realize your dreams. It is not necessary to complete a residency in family practice or Internal medicine. If you hang tight, many programs across the county have positions fall vacant, when someone no shows or accepts something else. I hire PAs and would love to have a nurse practioner. that being said I would much rather have an MD. I do not know who has been advising you, but unless your grades are atrocious you should stay the cross. I can be contacted at [email protected] if you would like to talk. I will call you if you wish.

  • “Even work as nurses?” Registered nurses are not medical assistants. We take microbiology, psychology, anatomy & physiology, chemistry and other prerequisites before starting a grueling schedule of coursework and clinicals. Medical school prepares no one to practice nursing (thus our nursing license). We know how to educate patients, comfort frightened children, titrate potentially lethal vasoactive drugs in ICU, and give a flu shot to a screaming child. There’s a reason someone who went to medical school (or is an EMT or a de tal hygienist ) has to go through the whole nursing curriculum.

  • After 200 k debt and 10+ hours of daily study for 4-5 years, how can we not get residency? This is nonsense. You think we are not humans, the average medical student studies 10-20 hours a day, you think we are doing all this and incurring all those loans for no reason. The reason why you doctor is making a load of money and doesn’t give a damn about you is because there is a doctor shortage and they are limiting residency spots to keep the doctors pay up.

    • The debt and medical school time commitment aside, the real question was raised in the article: Is residency as it exists today necessary? The mid-levels practicing independently certainly do not have the breadth and depth of training (NP and PA), but does an MD really need 3 years of residency to do the same work? I agree with Nurse Theresa, there’s a lot to in-house nursing as they are the eyes/ears/hands of the physicians. I also agree that residency positions are being severely limited and that does cause a shortage. This is a function of entitled teaching institution greed, coupled with the avarice of the ABMS. Except in a few states, without the board certification, which cannot be obtained without a residency, it is very difficult to get a job in medicine. I think it is clear that a residency does improve practice, certainly in advanced specialties, but no one has ever demonstrated that board certification really matters or makes a difference in the quality of care. But, the boards have convinced insurers and hospitals that it does, without evidence that it does, created endless and costly certificate maintenance requirements. While medical skills and knowledge have changed considerably, we should bring back a plain old general internship, make residency optional, and restore the ABMS back to what it once was: a means of demonstrating extra qualifications above and beyond, and not what it has become today: a professional testing organization which charges a fortune, doesn’t test what it is supposed to test, and has yet to demonstrate there is value. Second, COTH should not get extra money for residents beyond the first year. That will free up funds for more internships. Next, the ACGME should not be permitted to place program caps on residency programs, provided the programs meet the RRC requirements.

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