Put America First: US Citizen Medical Graduates Must be Prioritized for Residency Training To Fix Physician Shortage and Maximize American Interests

I graduated from a US medical school 5 years ago, but remain unmatched and with $475k in student loan debt for which interest is capitalizing at around $50k per year. These loans are currently in hardship deferral for which time is running out. As far as finding a “job” while reapplying for residency it has been extremely difficult. I am have taken temporary contract work in the gig economy which offers no benefits and is basically minimum wage. For other jobs, recruiters vary from no response to lamenting that I am overqualified or refusing to believe that I really have difficulty getting into a residency as an American graduate. This situation presents a “catch-22” of raising funds to apply to hundreds of residency programs [the residency match application, interviewing etc costs $3-5000+ and is done once a year] while taking care of the regular costs of living all from essentially minimum wage income.  I have done Uber, for example, where many people I encounter are shocked to find out that thousands of US citizen medical graduates are held out of training because of medical residency institutional policies that prioritize high scores from foreign medical graduates. Many program directors find new residents relatively docile and expect to extract more “mileage” out of foreign medical graduates by getting them to work longer hours without regard to their rights as might be objected to by American standards, effectively paying the foreign medical graduate a lower wage.

The medical institution where I studied, 80% of the internal medicine residents were non-US citizen graduates of foreign medical schools. This institution is located in the center of a predominantly African American city. These residents were not concerned about the patient population based on the complaints patients commonly made. As a rotating 3rd year student, many patients expressed excitement to see me since I was a US citizen trainee who typically is more culturally attuned to their issues. They have complimented me numerous times for my empathetic care. In general the patients have little trust that the foreign trained medical residents cared for their health adequately. Many of these residents spent minimal time in contact with the patients and I overheard one of the foreign schooled physicians condescendingly refer to practicing in this predominantly African-American city as doing “veterinary medicine.” The resident class is so skewed toward foreign medical graduates that US graduates can become isolated at academic meetings and during clinical rounds -practically the minority while working as an African American within a city that has an African American majority. Many foreign medical graduates as senior residents and program directors advocate for other foreign medical residents on admission committees and against US graduates. These policies concern who gets admitted to a program and lack any structure that aligns with the priorities and central interests of the United States of America and American citizens. It is their tax dollars that fund residency programs.

Further, the current state of affairs is representative of a long-brewing threat to American interests and even its national security. The preference for foreigners, motivated by factors such as effective lower wage (same pay but longer hours) is reflective of a broader pattern seen in graduate school recruiting and recruiting for other critical aspects of American scientific and medical research enterprise. Many chairs of academic departments travel to countries in South East Asia to recruit students and post-doctoral candidates in fields like biophysics, chemistry, computer science, genomics, etc.. In part by doing so they miss the opportunity to groom or invest in the local school populations through mentorship or recruitment programs.

American citizens and graduates of US medical schools live among the patients they care for and can better relate to the cultural factors impacting their care. My surveyed opinion is that they empathize better and are overall better clinicians because of it. Studies have shown that patients fare better when their caregiver population is reflective of the patient population they serve. US graduates also have a massive burden of federal and private student loans that is not shared by foreign medical graduates. No other country has a system whereby it is possible to prioritize other countries’ medical graduates over it’s own. This system of resident selection for American graduate medical education is critically broken and is causing undue suffering to American graduates and as such long term damage to critical interests of the The United State of America. There are thousands of American graduates on the sidelines waiting for a residency position but they are overlooked in preference of foreign medical graduates.

A potential solution I have for this problem is: medical residency programs give priority to U.S. graduates. This would be similar to the way government gives preference to veterans. In particular, a medical residency position should not be filled by a foreign medical graduate if there is a qualified US medical graduate or U.S. international medical graduate in the applicant pool. This is not radical, anti-immigration or the like. It is simply about taking care of American interests first. This policy is commonplace in many other developed countries such as the UK.. Before visas are issued the US medical graduates need to the given the opportunity to fill open spots, especially during this time of additional need due to the coronavirus pandemic instead of importing physicians.

One of the most fundamental problems leading to unmatched US graduates who cannot find jobs elsewhere is that  US medical education is based on an abridged model where medical students graduate but need to “match” into a residency alongside all other countries’ graduates in order to complete their training and be license-eligible independent practitioners. Imagine having a party at your house where you let everyone eat but make your family starve. We should no longer offer residency positions to the world without taking care of our citizens first. Giving people loans to go to medical school is in essence setting up some US medical graduates for lost wages from a lost career they were never given a fair shake at.

Clearly, additional long-term actions to fix this issue where the US graduate is competing against the entire world for a position to simply complete their training and be license-eligible is urgently needed.

No other profession in America graduates people who are not license-eligible, and then they have to compete with the entire world for a chance to simply finish their training as an independent professional!

This must stop.

We must stop wasting the lives of the thousands of intelligent highly educated American Citizens.

We must stop stealing physicians from other less developed countries and act responsibly.

We must finally take care of our own and put Americans first.

Thank you,



Edited by C.A. 10/19/20