By Ruth B. Hoppe
---- — In an Aug. 22 opinion piece, Mark Dubay endorses a bill recently introduced in the Michigan Senate would allow a doctor denied a residency to work with a limited license (Senate Bill 1201, 2012). Mr. Dubay asserts that the requirement that physicians successfully complete a residency is "why Michigan has a physician shortage".
Michigan has a primary care physician shortage because medical students are opting out of primary care careers (family medicine, pediatrics, internal medicine) due to compensation concerns and lifestyle issues that have been well documented. This problem is exacerbated by mal-distribution of physicians, with new doctors eschewing practice in rural locations.
Mr Dubay further incorrectly asserts that physicians who have not taken a residency are "fully licensed." The United States Medical Licensure Examination (USMLE) has three steps, two of which are taken before residency. The final step (Step 3) of USMLE is taken while residents are in training, which stamps the trainee as ready for unsupervised practice. At this point he/she is fully licensed. Most residents also go on to become board certified in their specialty, although certification is not required for licensure.
The bill Mr. Dubay cites actually proposes to forego residency training, not licensure, to allow otherwise qualified physicians to practice. This bill would seem to assert, completely without evidence, that physicians who have not taken three years (or more) of post-graduate training are as qualified to serve Michigan citizens as those who have. Residency training is the standard of the land; we should propose to ignore it at our peril.
Physicians who have "been denied" residencies are typically those least well qualified to practice in "unsupervised settings". Those who do not succeed in obtaining a residency are deemed by residency directors as being less qualified than and competitive with their peers, some of whom are international medical graduates.
To allow individuals who have not succeeded in securing residency positions to practice on Michigan citizens is not the way to address our physician shortage. We want the best physicians in Michigan, not those who may well have additional learning and experiencial needs.
The physician shortage is real. In the future, we will need more residency positions to accommodate the growing class sizes in America's medical schools and those international medical graduates who are competitive. We will also need health professions work force policies that make primary care careers more attractive to our graduates and may also need reform in the length and cost of the physician training pathway.
But Michigan citizens deserve the best and fully qualified doctors to deliver their health services — not those who have shorter training than those in other states. Ask you local state senator and representative to not support senate Bill 1201.
About the author: Ruth Hoppe, of Charlevoix, is a medical doctor and a Master, American College of Physicians Professor of Medicine, Emeritus, at Michigan State University, a senior consultant to the National Board of Medical Examiners and former chair of the United States Medical Licensure Composite Committee
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