Monday, October 13, 2014

The Residency Match 2015

OK      I'm in the Match again, praying for a residency to finish my training.

This is my third try to get into a residency.

In the United States licensing and practicing medicine is not federally regulated,
each state licenses a physician with its own rules and laws so if a physician is licensed in one US state and practice for 10 years, they want to move they must apply and their license may or may not be granted in the next state. For an American Medical School Grad (AMG) this is not an issue, for an International Medical School Grad (IMG) this can be a nightmare.

While the US states differ on rules and laws such as how many USMLE attempts will be acceptable for license, they agree on all of the following:

at least 1 Year of Residency for AMG to be licensed 3 years of Residency for an IMG to be licensed ( one state still allows 1 year to fulfill this requirement)

Passage of USMLE (United States Medical Licensing Exam) all three steps ( different rules on this in each states from unlimited time to 7 years to complete and Unlimited attempts to 3 attempts per step)

IMG must be ECFMG certified this is when the IMG passes Steps 1,2CK and 2CS, the medical degree is certified and clinical rotations.

What is new is the FCVS verification, see below from the site

FCVS Overview

FCVS was established in September 1996 to provide a centralized, uniform process for state medical boards to obtain a verified, primary-source record of a physician's core medical credentials. This service is designed to lighten the workload of credentialing staff and reduce duplication of efforts by gathering, verifying and permanently storing the physician's and/or physician assistant's credentials in a central repository............

Yes  the ECFMG may certify the all this but the Federation of State Medical Boards was not making enough money and the states were not uni-formally accepting the ECFMG certification and passage of the USMLE and a completed residency of 3 years in the USA as enough so now some states want the FCVS.  Whats next? A third verification company that each state board gets a fee too? It may be in our future.

What the average IMG pays for the match:

for 100 programs applied to $2175 in 2014

Funds for travel to residency interviews is around 300 to $500 in the USA from other countries more. 

From 100 programs applied expected interviews for average scores on USMLE and complete application package is 5 to 10 max. So usually less than 10% and if 5 interviews you will need at least $1500 for interview money.

This year and what has happened:

 We waited at our computers on the Morning of 9/15/2014 ready with a list to apply to and a Credit Card to pay our fees with ERAS running and crashing for over 6 hours. Few if any were able to apply to the programs. If we are to believe that at least 20,000 IMG's apply ( some say 40,000) and average 100 programs at least ( I know of many 200 plus) then the one day revenue from the 20,000 applications to ERAS is $42,000,000 gross for applying to programs. This is all done by computer software and servers. So the crashes? What is the most important part of this process? What makes ERAS a service? The application delivery, you see ERAS is a post office for the Residency programs.
ERAS stands for Electronic Residency Application Service. The sole purpose for the collection of fees from applicants is to deliver the residency application to programs.

So on the system crashed on 9/15/2014 and then we had an Email crash, messages from programs dissapeared and were not going through. Programs report difficulty in downloading applications and crashes on their end. After paying these fees and days trying to apply we have this from a service that had time to prepare and has been collecting these fees for years. I have my own thoughts on this and I have to tell you I think its a shame no one regulates this. Last year I found out about the software functions, a function to the programs is screener software. The screeners can be set to Year of Grad, Scores and Attempts on USMLE, ECFMG certified, Visa status, Citizenship. and probably other.
So the screener stops the application the applicant paid for ERAS to delver to the program. The program screens out your application and never see the application thanks to ERAS who you paid to deliver. The US Mail would never do this, we pay for the application to be delivered to the program it would reach them, if not the service was not provided. So if your application was screened out by ERAS own software, was service provided to you? Did you get what you paid for? You just paid a fee to have an application delivered but ERAS did not deliver it because the same computer system blocked it. Hmm think about it for  a minute.

I applied to 41 FM and 10 IM programs I hand picked because they say they look at the application.
I chose states I can be licensed in.
I chose programs who claim to care more about the applicant than scores.

I pray.

Good Luck

Sunday, October 5, 2014

Obama Care A mess?

Obama Care, Health care Act: 

Its a mess. Not to mention the Health Care insurance crises that is getting worse, Read the new articles

the Average person making 30,000 a year in the USA must have health insurance per the new Federal laws, great right? Wrong, they are paying at least 200 a month premium, then putting another 100 month into an account called "health savings" reducing what they make from 30,0000 to 26,400 then when they go to the doctor they find out that they have the average 6,000 per person deductible, They get one "free" visit a year, when they go to the ER or 2nd doctor visit, well its cash, all tests and services cash. 

My Wife and I had the BS insurance, Health savings had $400 in it because it was only few months into the year,  she had chest pain ( she is 50) and went to the ER, because she had an insurance card they did " everything" and all it was, was a muscle strain. Our bill was 5,800 for ibuprofen and rest. Her EKG was 550 for just test, 2,800 to be read, Chest Xray was $600 and $120 to be read, our deductible is $6000 and the insurance company sent a "congratulations you deductible is almost used up. 

I'm trying to get into a residency and do not make much
My wife makes 22,000 a year

The hospital refused to help us because we have insurance, they told us its against the new law, the insurance company told us we have to pay these reasonable prices, the hospital also said when we go to the ER they "can do and charge what ever they want" we lose the right to refuse per what they said, I protested the consults that happened after my wife left ( it cost an additional $500 or so)  the hospital and insurance said too bad we have to pay.

Do you really think this is going to work? 
Americans are not use to paying these prices for health care, infact we have already seen people tell us they cannot pay us at the clinic. Its going to get worse, we know it. Unemployment is 11.8% in the US ( this is the real number if unemployed and underemployed) 

If your an IMG thinking your going to make a lot of money in the US in future, I think your misguided 

The future of making the income physicians made previously in the US is seriously in jepordy.