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.
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.
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.”
U paid your way into your degree by going to a Caribbean Medschool and now are learning to be an NP via university of Phoenix online…. classic example of someone wanting the responsibility and perks of being a board licensed physician without putting in the work…
I was thinking the exact same thing. Something is off with this story….
Shh.. you have no idea what you’re talking about.
I think it’s actually much easier to get a residency than this article states, at least now. A relative of mine took almost 8 years to graduate from a Caribbean medical school, failed multiple classes in the basic sciences, failed a clinical rotation, failed USMLE Step 2 before passing, and is overall just a horrible candidate in every way imaginable. He is still getting interviews for residency which is mind-boggling and disturbing to me. Perhaps it is the new immigration laws that Trump has passed that are coming into play but I think US students who go to Caribbean schools are taking the place of better qualified foreign medical students who are not able to obtain visas whereas before this was not the case.
Hey man could you email me? I’d like to know more about this please. Thank you
[email protected]
Hi Joseph, I’m not an expert on this so I’m probably not the best person to ask. My comments are as someone who received an MD from the US some years ago and now has a lot of relatives both abroad and in the US who are going the Caribbean route and observing their results. At the same time, a good friend of mine is an Immigration lawyer and he has telling me that H1 visas are being hit especially hard in the IT sector although not as severely in terms of medical residency and higher “educated” jobs such as lawyers. I can tell you that there are students I know now with scores/statistics from Caribbean medical schools that would never stand a chance at getting residency prior to Trump but are getting them now. Even look at the countries as part of the “Muslim Ban”; I’m quite certain that countries like Iran used to provide a great amount of talented doctors to fill residency spots. It’s a shame that students who got an 18 on the MCAT and went to some Caribbean island because of poor scores are taking their spots but again I think this is temporary and will change when/if the immigration laws change to how they were before the lunacy of Trump. America First should not be at the sacrifice of American patients.
I find it insulting how these people did not get matched into an MD, and want to go into an NP program without doing their dues. RN students cannot just jump into an MD, there are prerequisites for each program, and each career has a different methodology. You need to be an RN first, and have a minimum of a year of experience to be an NP. Why do these people think they get special treatment to jump into an NP program?
Laura:
Actually there are plenty of reputable NP programs in the USA that allow you to to become NP without any RN experience. There is nothing insulting about an over qualified practitioner who wants to provide primary care any way they can.
I would imagine not being able to obtain an internship precludes a graduate MD from practicing in any area of medicine.Emergency medicine was a place that one could work without a residency in the past.
“My schedule is insane,” she said. “I stay up half the night taking online classes.”
That comment may be valuable insight into the reason for her not matching to a residency. Residents frequently stay up all night and are responsible for making decisions that are either lifesaving or life-ending during that time, after already working a full day. Is it just for the patients? Is it high-quality care to force sleep-deprived junior physicians to make such decisions without real backup? Of course not, but residents are cheap labor. Although one could absolutely argue that there is better opportunity for learning when not sleep-deprived, this system has been in place for decades and therefore has significant institutional inertia to resist any significant change. I was amazed that work hour restrictions have been accepted.
“She is back studying chemistry 101 and human anatomy . . .”
Furthermore, if she successfully completed medical school but needs to study Chemistry 101 and basic human anatomy we have an astronomically large problem here that she could graduate from an accredited medical school. Anyone graduating from any medical school who is worthy of a spot in post-graduate training for any medical or surgical specialty must know some very fundamental chemistry in order to understand biochemistry and pharmacology, as well as some anatomy to understand physiology, all of which are fundamental to understanding pathophysiology and clinical medicine.
Its possible that her chemisty and A&P courses were taken > 5 years ago, and need to be retaken to satisfy nursing admissions criteria.
Iam a foreign medical graduate who did not do residency and now thinking of becoming RN at azure college
Any advise
Hi Anjali , did you join Azure college, looks like it is an assosciate degree not regular bsn.rn degree, we can discuss iam also in the same boat looking further.
I have been a nurse for 25 years and I CHOSE to be a nurse not one by default. I take offence to people who treat our profession as if it some sort of boobie prize. I work with some “nurses” who were doctors in their home countries and could not pass the boards due to a language barrier, lack of knowledge or both. As a nurse with a MSN and currently in a doctorate program, whenever I have to review the importance of disease management with an MD/RN. I get the response “in my country I was a pediatrician, I know”. And I politely reply but here you are functioning as an RN. I don’t believe that rings true for everyone. I base my current opinion on what I encounter at work. I REPEAT. I AM NOT MAKING A GENERAL ASSUMPTION. JUST WHAT I HAVE ENCOUNTERED AT WORK.
I can write a book on basic skills that are not there because they never step foot in a nursing school, feel they are above taking direction or constructive criticism or realize the profession evolves and they must also.
And the sad reality is that if some of these “drop outs” passed their boards or obtained a residency they wouldn’t respect what we do as nurses.
To the narrow minded troll, in light of recent events regarding paying for your child to get into college not based on grades but money. You should rethink your belief regarding people of color getting into med schools because of their ethnicity. No one in my family got a free ride. We were taught the importance of a strong education and hard work equals success. Stop perpetuating stupidity.
America doesnt have a np to md program
Seriously Ali, I have met MDs who were dumb as rocks. They may have been able to pass the tests, but have no EQ. Where was your residency? Persistence is more important than intelligence for MDs. We do know that there are more Med School graduates than residency placements. BTW, I am a nurse who never had the privileges many who go to Med School have, poor, minority, uneducated parents. Your assumptions are narrow and biased.
Is there a reason why my comment was deleted?
If you dont match into residency these days , that means you didnt try enough during medical school, which means you didnt care enough about patients to study hard. If you were just not doing well despite studying hard in the beginning, you should not have waited until graduating to switch professions. There is a reason why medical school is hard. It is for people who can handle the amount of knowledge that the profession entails so that patients can be treated better. This article is just one example of a person who should not have even gone to medical school in the first place. If you knew you weren’t qualified to learn everything necessary to be a great doctor, then you did it for the wrong reasons. Sure, many people think “I care so much about patients so I want to be a doctor” but if you aren’t smart enough to gain the knowledge necessary to treat them properly, all the caring in the world wont make up for their death that resulted from your incompetency. Leave the hard work for those who can handle it and stop trying to be something you can’t be. In this life, you can do anything, but if you aren’t good at it, you only end up hurting people. In this case patients.
My mother was the only Black, Dominican woman in her medical school class. Not only did she graduate with honors, but she also won a humanitarian award – just in medical school – passed 1st USMLE before residency, 2nd while in her first year. Pretty typical. However, there were no representative people anywhere to help her, like there are for most cultures. She was again the only Black, Dominican woman in her residency and one of only 4 over 35; her age had been brought up a lot during residency interviews. Even though her residency was with a collection of hospitals, they only sent her to the worst ones during rotations. She was often left, as a first year, without a 3rd year or attending, to do major care. When she inevitably made a medical mistake because no one was training her like they should have, the hospital went through great lengths to cover it up instead of seeking the personal and systemic accountability she sought out (she didn’t win the humanitarian award for performing, she walked the path). The corruption of the system is what led my mother to leave her residency.
Not a lack of brains out gumption. A toxic, oppressive work environment with compounding labor abuse. She thought about trying to be a NP but no one at that point would loan her more money on top of her medical school debt (falling in line with the data we know know about racial inequality in loan approvals). They’re absolutely should be a fast track to NP from an MD the same way it exists from NP to MD.
Anyone who suggests doctors only drop out because they’re not smart enough haven’t been paying attention to the amount of privileged, fatphobic, toxic cis-men practicing medicine today. Thank goodness I have medical people in my family or my own PCP would have killed me prescribing drugs that would make my other illnesses flare up. The world needs practitioners like my mother. People who care about patients, and treat them with the same love and courtesy they give their own children and parents.