Medicare Enrollment Application For Physician And Non-Physician: Fill & Download for Free

What is PECOS?PECOS stands for Provider Enrolment, Chain and Ownership System and it is an excellent alternative to paper applications as it allows the users to securely submit and manage medicare enrolment information electronically. It provides an electronic database to record and retain data of the medicare enrolled suppliers and providers. It was very helpful in recognizing the illegal medical providers as all the providers, suppliers and people were linked through this system. It makes the task of licensing and enrolment easier for medical service providers and enables them to work in a hassle-free manner.Why PECOS?PECOS was developed by CMS under the provisions of the Patient Protection and Affordable Care Act. According to the regulation, all the physicians who order or refer home healthcare services or supplies have to enroll with the Medicare or PECOS to continue their service. From January 6, 2014, the CMS started denying claims for Medicare home health services or supplies from all the physicians who were not registered in PECOS.Physicians who care for Medicare patients should necessarily get themselves enrolled in PECOS so that their patients can receive the care and supplies they need in a timely and effective manner. It is an essential requirement for all the physicians if they are dedicated enough to provide the best care and treatment to all their patients.Registration with PECOSRegistration with the PECOS is completely free and it is fast and easy. It ensures that the patients can receive the care that they need as and when they need it. The medical practitioners or the service providers can either do the process themselves or they can get it done through a third party like HRX which can save you from all the cumbersome paperwork. The steps in the registration process are: Arrange all the documents and information that is required and are mentioned in the pre-enrolment checklist of the PECOS. It is necessary to arrange all the documents properly so that there is no delay or denials in registration and payments.Go to the official website of the PECOS and register yourself for a user account. The link for the same is provided on the website.Continue through the entire process to register you with the PECOS. Accept all the terms and conditions and click on the accept button once the registration is complete.After completing the application you are required to print, sign and put the date on the certification statement provided over there.Mail the certification certificate duly signed and filled by you along with all the necessary documents to your designated Medicare contractor. The process should be done within 7 days of submitting the document electronically.PECOS credentialing is very easy and it is necessary for all the medical practitioners as it ensures that they get paid for their services and can provide home health services without any hassles. With the internet-based PECOS, all the physicians, non-physician practitioners, medical service providers, and all the other supplier organizations can enroll and modify their Medicare enrolment, view the entire Medicare enrolment information, or check on the status of a Medicare enrolment application on the internet. Thus PECOS credentialing is important to continue the practice in the best manner as well as provide the best care to the patients without having to worry about any verification or payment delay and denials.HRX- The leading credentialing companyHRX is a leading organization that provides credentialing, enrolment and licensing services that can help you a lot by eliminating all the extra paperwork and making the work easier for you. The team of experts handles the entire process for you while keeping the record most efficiently. The team of HRX has worked with more than 10,000 healthcare professionals for over 10 years because of which they can speed up the work of the PECOS credentialing.The entire application, enrolment, and re-validation are handled by the team of HRX is a cost-effective and quick manner. After registering yourself, it is necessary for the medical practitioners to re-validate and updates the information every 3 to 5 years. Even that work is handled by the team of experts to ensure that there is no delay. So if you are worried about the PECOS credentialing, then HRX is the place for you!

The American health care industry wastes $1T by some estimates, and possibly as much as 30% of health care spending by others. US health care expenditures are twice the OECD average – for instance, we spend twice what the UK does on health care (as a percentage of GDP) – and American health care costs are growing at 5% a year.Healthcare presents one of the greatest policy challenges for our country because profit incentives and care for the patient are often misaligned. It’s clear that the government is going to play some role in making sure the least well-off Americans have access to medicine, but we need healthcare policies that incentivize providers and payors to educate patients to make informed, data-driven choices. Only intelligent consumer choice will stimulate functioning, competitive markets in insurance, patient care, the pharmaceutical industry, and elsewhere. Today, pharmaceutical companies, health providers, electronic health record (EHR) systems, and other actors often have misaligned incentives and fail to enable more efficient solutions that do more for the patient per dollar - indeed, often the winners in these areas are those that unnecessarily charge more. Aligning incentives will spur top technology startups to develop innovative healthcare solutions, bring down costs, and deliver superior outcomes to American patients. Here are a few necessary reforms:Medical SchoolsExperts project a total physician shortfall of between 42,600 and 121,300 by 2030.* We need more medical schools fast, but the Liaison Committee on Medical Education accreditation process takes 8 years on average and most states require new medical schools to obtain a “certificate of need” before beginning construction. In addition, medical schools are required to sustain the high overhead of medical research rather than focusing exclusively on training doctors, and inflexible requirements prevent medical schools from experimenting with new curricula. Organic chemistry and other undergraduate prerequisites are completely irrelevant to becoming a good practicing doctor, and should be optional.High medical school costs force students to become high-earning specialists, e.g. plastic and orthopedic surgeons, when our country really needs more primary care physicians (PCPs). Primary care physicians, nurse practitioners, and physician’s assistants are far cheaper than specialists, but limited medical school and residency supply as well as occupational licensing concerns keep them out of the market. In addition, foreign doctors are almost always required to complete a full residency before being allowed to practice in the United States. Given a current skills gap of 30,000 doctors, adding 30,000 new PCPs, nurse practitioners, or physicians assistants could save $2.3B, $5.1B, or $6B in salary costs alone relative to the current mix of specialists and primary care doctors.In addition, primary care doctors achieve better health outcomes for patients than specialists by engaging in long-term counselling, tracking, and preventive care. Scholars estimate that replacing specialists with primary care physicians at a density of 1 per 10,000 population could save $931 per beneficiary a year. Adding a supply of 30,000 primary care physicians would save our country about $150-200B a year.*If implemented correctly, data-driven telemedicine can ameliorate demand for physicians somewhat. Doctors should be able to digitally prescribe most drugs, and data from increasingly sophisticated wearables will enable physicians to swiftly and efficiently diagnose patients.Reform PBMsIn 2017 the Centers for Medicare and Medicaid Services (CMS) spent $175B on prescription drugs alone, and there are currently shortages of vital drugs across the country. An oligopoly of Pharmacy Benefit Managers (PBMs) generates $200B a year in revenue by forcing drug manufacturers to pay rebates and other kickbacks in order for the PBM to place their drug on the “formulary”, or list of insurable drugs. Securing a place on the formulary is a matter of life and death for manufacturers, and by one estimate the current value of rebates and other price concessions from manufacturers to PBMs increased from $59B in 2012 to $127B in 2016.After speaking extensively with politicians on both sides, we were thrilled to see the Senate recently outlaw PBM “gag-orders” on pharmacies by a 98-2 vote. We are encouraged to see that Alex Azar’s Department of Health and Human Services (HHS) is planning to subject PBM rebates to anti-kickback law, but we would go further and require full price transparency on PBM contracts in the style of Colorado HB 1260. Although some rebate money flows to insurers, we estimate that reforming the space could save America on the order of $50B.End of Life Palliative CareAlthough discredited by hyperbolic language about “death panels”, counselling patients at end-of-life is both cost-effective and humane. 30% of Medicare expenditures are attributable to 5% of beneficiaries who die each year, and acute care in the final 30 days of life accounts for 78% of the costs incurred in the final year of life. While acute-care for the dying should obviously be available to those who want it, our country must shift to a model of counselling and palliative care at the end of life.Just having an end of life discussion with the cancer patient reduces medical costs by 35.7% on average, and given that there are roughly 600,000 cancer deaths in the United States a year, would have saved $687M a year for cancer patients in the last week of life alone! In addition accountable care organizations (ACOs) have saved $12,000 per patient during the final three months of life by implementing home-based palliative care. If extended to all cancer, end stage renal disease, and congestive heart failure patients this program could save the country $11.7B a year.We all agree that we must treat families of the dying with delicacy and compassion. But introducing a program by which families will share in Medicare/Medicaid savings from palliative care would help families and patients factor the overall social cost of end-of-life care into their decision calculus. We estimate that extending proven programs and testing different incentives structures could save our country $30-50B a year.FDA ReformClinical trials are an arduous multi-year process and have become drastically more costly in the last 30 years. Phase II and III efficacy trials cost roughly $400M per new drug, which severely limits the number of drugs that make it to the final stage of Food and Drug Administration (FDA) approval. A “progressive approval” approach would allow drugs to be repurposed for other uses and possibly sold after passing Phase I safety trials, which establish that a drug has a favorable risk balance and qualifies as value-based care. Drug companies could gradually establish efficacy by logging the effects the drug has on each person who opts to use it over the next several years.The extreme costs of clinical trials and FDA approval not only stymie drug development and the application of treatments to new indications, they effectively privilege Big Pharma over other innovators, inhibiting innovation and medical progress. A data-driven approach in which doctors and hospitals verify drug efficacy over time would allow the FDA to concentrate its resources on ensuring safety, particularly as the market for new drugs becomes sophisticated at assimilating information from the progressive approval process. While ramping up the number of drugs approved may not save our healthcare system money on net, a framework which encourages innovation will positively impact millions of lives by improving quality of care.Give Medicare Negotiating PowerTo pass the Affordable Care Act (ACA), the Obama Administration made a critical concession: Medicare would not be able to negotiate the price of drugs by controlling which drugs make it onto Medicare’s formulary. As a consequence, our federal government is a “price taker” that must blindly accept whatever prices drug companies demand, and the American government winds up subsidizing drug development costs for the rest of the world. Drug prices at home are extremely high, representing 10% of total healthcare expenditures, and about $144B of federal healthcare spending.In many other developed countries, governments use their monopsony or near-monopsony buying power to force pharmaceutical companies to sell drugs at much cheaper rates. For instance, Canada spends 70% of what the US spends on brand name drugs, the UK 40% of what we spend, and Denmark only 35%. If the US federal government used its considerably larger “countervailing power” to negotiate reduced drug prices – whether on a case by case basis or by pegging the value of a Quality Adjusted Life Year at a generous but fixed rate - savings could be in the range of $30-40B, possibly even as high as $90B a year.Pharmaceutical industry lobbyists (PhRMA) argue that high drug prices are necessary to stimulate R&D which generates many new life saving drugs every year. But in fact, median R&D spending on new cancer drugs – the most difficult to develop – is only around 40% of total revenue. In addition, most R&D is funded by American universities, and manufacturers of silver-bullet specialty drugs could continue to charge high prices to a federal payor. Giving government negotiating power isn’t a novel solution, but it’s one of the correct solutions to driving down drug costs for Americans.Tort LawThe threat of malpractice lawsuits forces doctors to engage in costly defensive medicine. Although the current administration has made some progress on tort reform (making arbitration legal for federal contractors and nursing homes), Congress must insist on Texas-style reforms including capped punitive and noneconomic damages from healthcare providers, eliminating contingency fees for speculative tort lawyers, reinforced federal preemption doctrine for food and drug products, and more. Unfortunately the trial lawyers lobby – one of the biggest political donors in the country – will fight reform at every step of the way.Some studies estimate that reducing physician malpractice fears to “somewhat concerned” about malpractice would decrease costs by 14%, saving the country $100B a year. Others argue that medical liability reform could save our country up to $210B a year. Congress must protect our doctors from being attacked by unscrupulous prosecutors in order to reduce the cost of healthcare for American citizens. We all agree that we must insist on protecting patients, but unchecked tort lawsuits just punish American patients and taxpayers with an unaffordable system.Data InteroperabilityThe ACA’s “meaningful use” requirements did little to make healthcare data accessible. As of 2015, only 6% of health care providers could share patient data with other clinicians who use an EHR system different from their own. Although 21st Century Cures Act made “information blocking” illegal, big EHR vendors routinely prevent their competitors from importing patient data by disclosing health records in garbled, incoherent formats. As a result, physicians are unable to make fully informed decisions about their patients.Judy Faulkner, CEO of EPIC, famously condescended then Vice-President Biden, “Why do you want your medical records? They’re a thousand pages of which you understand 10.” The answer is that only real, semantic interoperability which makes health data available to third parties via and open application programming interface (API) will allow an innovation ecosystem of apps, medical devices, and novel insurance plans to flourish. Granular, transparent healthcare data will allow entrepreneurs – whether college students or IBM executives – to invent new solutions from the bottom up and swiftly incorporate best practices into their businesses. In addition, direct service-to-service comparisons will allow consumers to make informed decisions about how to stay healthy, stimulating market competition for their dollars.We have been excited to see CMS’s Blue Button 2.0 API program formalize the Fast Healthcare Interoperability Resources (FHIR) standard for health records, which includes programmer resources, a complete API, and gives beneficiaries full control over their data – but EHR providers are refusing to use it. While any EHR system should ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) by storing protected health information on secure servers, we need to make interoperability truly mandatory.If patients could easily share their medical records with new providers and selectively reveal their data to health apps, fitness devices, diagnostic companies, insurers, and academic researchers, our entire healthcare industry would become hugely more affordable and effective. Reliable, real-time information about which treatments work, which failed, and what they cost will enable hospitals to identify and minimize cost centers as they strive to produce care more cheaply than federal benchmarks and share in the savings.Financing ReformOvertreatment and poor physician incentives may be the main driver of health care costs. Most hospital networks are local monopolies with limited incentives to innovate or save money. Replacing this broken system with value-based care models will immediately save over $100B in total, and should grow steadily over time to $200-300B as doctors harness digital technology interventions and other new techniques to make care cheaper and more effective. We break down a few potential sources of savings below:Bundled PaymentsThe Bundled Payment Care Initiative (“BPCI”) introduced in 2013 shows serious promise in making acute care clinical workflows more efficient, particularly in orthopedic care and oncology. Results continue to improve as providers adapt to the program.After adopting a bundled payment model, the NYU Medical center reduced costs to Medicare by 10% and reduced patient stays by 25% for total hip arthroplasty procedures, and a private practice joint arthroplasty generated 20% savings for CMS per episode while decreasing readmissions. The Congressional Budget Office estimates that a voluntary bundled payments system could save Medicare $6.6B a year. If CMS makes bundled payments mandatory for both Medicare and Medicaid, achieves health record interoperability, and allows the ecosystem to iterate on data-driven incentives, we expect savings to surpass $100B.Accountable Care OrganizationsACOs are widely seen as the Affordable Care Act’s main instrument to rein in health care spending, and ultimately we expect that bundled payments will be folded into a broader ACO model. To date ACOs have generated modest savings on average, but some, such as the Memorial-Hermann ACO, have generated 11% savings for Medicare. ACO contracts are more efficient if they involve two-sided risk (rewards for savings, penalties for overages), but studies have shown that even early versions of upside-risk only ACOs are associated with a 3% reduction in Medicare reimbursement. In addition, Medicare ACOs have improved quality measures across the board, despite their old, sickly populations.Provider networks are still adjusting to the ACO model, and returns will increase in the future. Projecting savings at 5-10% and assume that all Medicare beneficiaries are enrolled in ACO providers, ACOs would save Medicare $30-60B a year. If extended to Medicare and Medicaid, full ACO enrollment could generate between $56-112B a year.Preventive MedicineThe ACA now mandates coverage for all evidence-based prevention in non-grandfathered plans, so preventative screening and vaccinations have increased since the advent of Obamacare. However we need to drastically increase the scope of preventive medicine under the aegis of value-based care. Preventable chronic diseases are 7 of 10 top causes of death in the country, and account for 75% of health care costs. Half of American adults have chronic disease, and surprisingly, chronic illness among those younger than 65 years accounts for 67% of total medical spending. 70% of American adults are overweight, and 1 in 3 American kids and teens is overweight or obese. Prevalence of obesity has tripled since 1971.Some of the most cost-effective, successful preventive health interventions include childhood immunization, youth and adult tobacco counselling, alcoholism interventions, aspirin use for people with heart disease, and screenings for common cancers, STDs, and chronic conditions like hypertension. Evidence suggests that many other preventive health interventions are cost-neutral or increase long-term medical costs (because they extend lifespans). However critics often miss the fact that preventive health measures will extend the working careers of Americans, and pay for themselves in the long-run.In kidney care, for example, the federal government subsidizes extremely costly dialysis treatments for end stage renal disease patients but has not crafted incentives to perform preventative treatments before a patient advances to this critical, debilitating condition. Rather than fill the coffers of the corrupt duopoly that runs the dialysis industry, we should give providers incentives to halt the progression of kidney disease in its tracks. As a country we spend $42B on hemodialysis. Just getting prevention right here could save our system north of $10B a year.ConclusionFixing our sprawling, tangled healthcare system is one of our nation’s greatest policy challenges. In the coming years, America should move swiftly to embrace value-based care models which align market incentives to produce a wealth of patient data and an ecosystem of new information technologies geared at preventive treatment. At the same time, we must address specific areas where poor incentives have throttled the production and delivery of medical services. Replacing bureaucratic mandates with proven Western values of entrepreneurial innovation and educated individual decision-making will yield better patient experiences and results for Americans from every walk of life while saving our country $600-$900B annually – a transformative amount of money for the well-being of our nation.

Q. Are there graduates of medical schools (MDs and comparable) who are unable to get into a residency program? If so, what happens to them?A. A few articles of interest:Understand Your Odds of Getting into ResidencyShortage of residency slots may have chilling effect on next generation of physiciansOptions Exist for Med Students Without Residency Matches (usnews.com)Medical Students Match Day (statnews.com)Unmatched Graduate: “Med Schools to Blame”Foreign medical graduates get a raw deal. Here's why.Understand Your Odds of Getting into ResidencyMARCH 08, 2017 Heidi Moawad, MDIn recent years, we have all been hearing more and more in the medical community about doctors who are not able to successfully get into a residency training program in the United States. Physicians in this predicament are in a difficult jam, unable to proceed with a career they have spent so much time and money working toward, while at the same time, unable to get work in most other desirable professions, which also require years of specialized education and internships.Many aspiring physicians wonder about the numbers behind this bleak situation and what it means for them. If you have been unable to match so far – or if you are apprehensive that you may have a low chance of matching – the statistics behind this problem can help you gain some insight into your chances of getting into an accredited residency program.MATCH PROGRAM FACTSThe National Residency Matching Program (NRMP) itself, which is the organization that matches physician applicants to U.S. residency training programs, provides a uniform process for all applicants, with consistent application deadlines and scheduled announcements of match results.According to the most recent NRMP results from 2016, there were more than 35,000 applicants for approximately 27,000 PGY1 positions. The gap between applicants and positions is the reason that there are so many medical school graduates who are not able to work as doctors. Of these applicants, about 20,000 are graduates of U.S. medical schools, and the remainder of physician applicants are International Medical School graduates.While there are certainly a substantial number of physicians who do not match in a residency spot, there were more available positions for PGY1 spots this past year than ever before. But, the number of applicants for the 2016 match reached an all-time high. The number of U.S. allopathic medical school and osteopathic medical school applicants was only about 20,000, which is substantially fewer than the number of residency positions available. And, it turns out that most (more than 95 percent) U.S. graduates did match in a residency program.However, there are hundreds of U.S. medical school graduates who do not match each year. U.S. medical students who were not recent graduates had a significantly lower match rate than recent graduates, for various reasons. And American students who graduated from international medical schools did not fare as well as American students who graduated from U.S. medical schools, with a slightly higher match rate than non-U.S. citizen International Medical School graduates, which was little more than 50 percent in 2016.LARGER NUMBER OF APPLICANTSThere has been a larger number of applicants than ever before because most of the applicant groups are growing. There are slightly more U.S. allopathic medical school graduates, more U.S. citizen International Medical School graduates and more Osteopathic medical school graduates, which adds up to more applicants. And, there are more non-U.S. International Medical School graduates applying for residency spots as well. Despite all of the negativity about the medical field, there are still huge numbers of people who want to work as physicians, particularly in the United States, where most doctors perceive the system to be relatively fair, uncorrupt and of high quality.Interestingly, there are also many non-U.S. International Medical School graduates who do not even apply for the match because they have not passed USMLE tests, have scored low on the examinations or have other concerns that make it impractical to apply. And a large number of non-U.S. International Medical School graduates apply for residency, but receive no interviews, and thus do not have the option to proceed with ranking programs in the match.DO YOU HAVE TO MATCH TO WORK AS A DOCTOR?While you can take USMLE parts 1 and 2, and there are special circumstances that allow for you to take USMLE part 3, each state has its own requirements for medical licensing. At least one to two years of residency or internship training is typically required in order to obtain a medical license. If you want to work as a clinical physician, it is best to try to get a position through the match, or shortly after the match during the so-called scrambling period if you do not match. In fact, there are even instances in which physicians become ill or leave training programs, opening unexpected slots that need to be urgently filled at any time during the year.Physicians who want non-clinical work can succeed without residency training, but residency training even helps open the non-clinical route to better options. Therefore it is worthwhile to continue in the process, even accepting a position in a less desirable specialty, whether your aspiration is patient care or non-clinical work.There are options for doctors who do not have residency training, however. To get the most updated information, visit Careers for Physicians Without Residency, which is regularly updated with more opportunities.Shortage of residency slots may have chilling effect on next generation of physiciansBY BRUCE KOEPPEN, M.D. — 01/22/16 11:00 AM ESTMost people are aware of America's looming physician shortage, but the shortage of residency slots for medical school graduates has received less attention.In order to practice medicine in this country, graduates of allopathic (MD) and osteopathic (DO) medical schools must complete a residency training program. In recent years the number of MD and DO graduates has increased by more than 23 percent in an effort by schools to address the country's growing physician shortage, which the American Association of Medical Colleges estimates will approach 90,000 too few physicians by 2025.While the number of medical school graduates is increasing, the number of residency training positions has not kept pace. If this imbalance is not addressed, the number of American MD and DO graduates will exceed the number of first-year residency positions, which by some estimates could occur as soon as 2017. When this happens, young physicians-who dedicated years to the pursuit of a medical education and incurred significant debt doing so-will not be able to practice medicine, and the physician shortage will persist.Part of the problem stems from the funding mechanism for Graduate Medical Education (GME). Medicare covers the majority of the cost teaching hospitals spend on training medical residents, but the Balanced Budget Act of 1997 capped the number of residency slots the federal government would fund. The shortfall-what is not covered by the Federal government-is paid for by the hospitals where residents train. While it is possible to increase the number of residents they train, to do so, hospitals must fund the entire cost of those training positions.Though patient care has shifted its emphasis to wellness and prevention, the current reimbursement system has not yet caught up. It is still based on the number of procedures performed, incentivizing hospitals to fund additional residencies in revenue-producing specialties instead of primary care.Adding to the problem, are for-profit schools that pay hospitals for medical student residency training spots-an incentive for some cash-strapped hospitals-something that is a growing concern among medical school deans. Residency slots that are taken by trainees from non-accredited schools reduce the number of slots available to trainees from accredited allopathic and osteopathic schools.Some of these non-accredited for-profit schools train as many as 1000 students a year without clinical facilities or full time faculty. According to a 2013 Bloomberg Markets investigation, many students who attend these schools incur tremendous debt and fail to complete the programs; many of those who complete the programs are unable to find a residency.The shortage of residency slots is also affecting graduates of accredited programs. Last year, more than 500 graduates from US allopathic medical schools were unable to obtain a residency training position. As more students graduate from medical school in the coming years, this number will only increase.We need to find ways to address the shortfall. There are several solutions being considered.The Foreign Medical School Accountability Fairness Act, a bi-partisan bill from the House and the Senate that would protect taxpayers and students, eliminates an exemption that entitles certain foreign medical schools to US Department of Education Title IV funding without meeting minimum requirements. The bill would ensure that 60 percent of enrollees in medical schools outside the US and Canada must be non-US citizens or permanent residents and have at least a 75 percent pass rate on the US Medical Licensing Exam.Other pending legislation includes the Training Tomorrow's Doctors Today Act, which would add 15,000 new residency training positions over the next five years; and the Resident Physicians Shortage Reduction Act of 2015, which aims to protect against the rapid shortfall of primary care physicians.The Affordable Care Act's $230 million Teaching Health Center Graduate Medical Education Program is designed to train primary care physicians mostly in non-hospital settings, which is exactly where the majority of primary medicine is practiced. Moreover, many of these new training programs serve underserved communities. These residency programs do not rely on Medicare funding, but must be self-supporting by 2017.These efforts all have merit, but the wheels are turning slowly and the clock is ticking. Training physicians doesn't happen overnight. Our lawmakers need to move quickly for the sake of patients and the physicians who have invested so much time and effort into learning how to care for them.Koeppen is founding dean of the Frank H. Netter School of Medicine at Quinnipiac University.Options Exist for Med Students Without Residency Matches (usnews.com)Few days are as important as Match Day for a medical school student.Dozens of videos on YouTube show students crying tears of joy and hugging classmates as they finally learn, this year on March 15, where they will spend the next three to seven years doing their residency. This day marks the unofficial end of medical school and the beginning of a career as a doctor.[Learn about recent changes in the matching process for residents.]On the Monday of Match Week, students learn if they were matched with a residency program. This year there were approximately 40,000 registrants. Unmatched students – this month, 963 registrants were unmatched, according to the National Resident Matching Program – are automatically entered into the Supplemental Offer and Acceptance Program, a one-week process that allows them to apply for unfilled residency positions.Residency offers through SOAP "continue through Friday of Match Week, and that process has been very efficient," says Hal Jenson, president-designate of the National Resident Matching Program.Before SOAP was created, students went through a similar process called "the scramble." But even with coordinated, last-minute efforts to place students, some still find themselves without a residency.After not matching in anesthesiology in 2010 and then failing to find a residency program through the scramble, one aspiring physician spent a year teaching anatomy, physiology and microbiology at a technical school until the next match."I still wanted to do anesthesiology, but I left it open to other fields as well. It sort of becomes a you-take-what-you-get type of deal," says the now second-year resident, who asked not to be identified. He settled for internal medicine."Initially you are disheartened, but what can you do about it? Either you sulk, or you fix it and figure out another situation," he says.[Find out how medical residency work hours can vary.]Experts say there are typically two reasons students don't match. They apply for highly competitive residencies, such as dermatology or radiology, even though their medical school performance makes them unlikely candidates for those slots, or they place too few schools on their ranking list, which they give to the National Resident Matching Program.While unmatched students can take alternative routes to residency, many in the medical field agree it's best to avoid the situation outright. One way is to rank several residency programs at which a student has interviewed."I tell medical students they should always put at least five places," says Stephen Klasko, dean of the University of South Florida Health's Morsani College of Medicine. He encourages students, particularly those who didn't initially match, to expand the number of hospitals they are willing to go within their chosen specialty, or consider choosing a different specialty.Lynn Buckvar-Keltz, associate dean for student affairs at the NYU School of Medicine, says grades and exam scores matter when applying for residency, but those aren't the only factors."Being an engaged, enthusiastic member of the clinical teams during the clinical clerkship is an important part of the student's medical school experience and therefore their residency application as well."[Follow a day in the life of a medical intern.]If an aspiring physician is unmatched, there are a few options.Students can contact their medical school and ask for a transitional slot, which mimics the fourth year of school, or seek a research fellowship."If they do a transitional year or a research fellowship, they can then become more competitive in one of those specialties or they can decide to match in family medicine or general internal medicine where it's easier to get a slot," says Klasko.Obtaining another degree could also increase a student's chances of matching in the next cycle, Klasko says."Now all of a sudden I'm a pretty cool candidate," he says. "It doesn't look like I'm somebody who failed. I'm somebody who decided to get a master's in public health or an MBA. Now I'm a differentiated candidate."Searching for a medical school? Get our complete rankings of Best Medical Schools.Corrected 4/10/13: A previous version of this article misstated the name of the National Resident Matching Program.Tags: doctors, education, graduate schools, medical school, studentsDelece Smith-Barrow is an education reporter at U.S. News, covering college admissions; she previously wrote about graduate schools.POLITICSMedical Students Match Day (statnews.com)Looming question for medical students: Will they be shut out of advanced training? By MELISSA BAILEY MARCH 17, 2016Dr. Heidi Schmidt looks on while a nurse takes the vitals of a patient in a medical clinic at the St. Vincent de Paul food pantry in Indianapolis.They’re about to graduate from medical school with an MD to their names, but hundreds of students across the US learned this week that they haven’t advanced to the next step of training — and will not be allowed to practice medicine.Most medical students found out Friday where they’re headed for their residency, where they’ll work alongside licensed doctors, gradually gaining more responsibility. But each year, a sizable group learns shortly before the official “Match Day” that they’ve been shut out of this training.This year, for instance, more than 29,000 applicants got placed in a first-year residency through the main matching process. But 8,640 did not — a number that includes international applicants and aspiring physicians who graduated from medical schools in recent years, as well as current fourth-year students.That mismatch has prompted a policy debate: Should the rural and urban clinics that struggle to find doctors be allowed to scoop up unmatched graduates so their talents don’t go to waste? Or would it be dangerous to put them in front of patients without a traditional residency, which typically lasts at least three years?Missouri, Kansas, and Arkansas have passed laws to allow unmatched graduates to work in medically underserved areas without doing a residency.Otherwise, “a lot end up wasting all of their education, because there is no place for them in the health care delivery system without having a residency,” said Dr. Edmond Cabbabe, a plastic surgeon in St. Louis who conceived of the Missouri law.Passed in 2014, but not yet implemented, the law will create an “assistant physician” license for these newly minted doctors, who will work with a collaborating physician. That physician will have to directly supervise the new doctors for at least a month before they can see patients on their own. One impetus for the law: Nearly all of Missouri’s 101 rural counties face a shortage of primary care providers.Arkansas this year approved new rules allowing recent medical school graduates with ties to the state to work as a “graduate registered physician” before residency. Kansas, too, created a special license; it’s restricted to graduates of the University of Kansas School of Medicine who strike out in the match process, and it allows them to work, under supervision, for just two years. At that point, they’re expected to move on to a residency.Related Story:Medical students demand an end to pricey exam testing patient care skillsWhile supporters hail such laws as a groundbreaking solution, the medical establishment has frowned on them.The Association of American Medical Colleges “is concerned by efforts that would bypass the experiences necessary for physicians to provide safe and effective patient care independently,” said Tannaz Rasouli, AAMC’s senior director of government relations.The American Medical Association also came out against such programs. Instead, it has called on government, insurance payers, and foundations to pitch in money to create more residency spots.So far, no one is practicing medicine under any of those new regulations.But they could help MDs like Dr. Heidi Schmidt, a Juilliard-trained opera singer and entrepreneur who graduated from American University of the Caribbean School of Medicine on the island of St. Maarten. She received honors in clinical coursework, but struggled with standardized tests and had to make multiple attempts to pass two national board exams.Residency programs often see multiple board exam attempts and degrees from foreign medical schools as red flags when evaluating candidates.Schmidt, who also has master’s degrees in public health, music, and pharmaceutical science, has the title “doctor,” but her options are limited. Without at least one year of postgraduate residency, she can’t practice medicine in the United States. To work as a nurse or a physician assistant, she’d have to go back to school and get a different degree.To stay in medicine, she volunteers in Indianapolis at Gennesaret Free Clinics for the homeless and working poor. She sees patients, but she said a licensed physician must sign off on all her work. Schmidt said she can’t get paid until she becomes a licensed physician. And she longs to treat patients on her own.“My dream has always been to be a physician for the poor,” she said.Dr. Heidi Schmidt at the St. Vincent de Paul food pantry in Indianapolis, Ind. After not being matched with a residency, Schmidt’s plans of becoming a licensed doctor are on hold, so she volunteers at a medical clinic there.LUCAS CARTER FOR STATSeniors in traditional (non-osteopathic) US medical schools have better odds than those from foreign schools: Their match rate has hovered around 94 percent. But that still means 1,130 didn’t get a residency in the main match this year.That news can be a shock. As a senior at the University of Virginia medical school last year, Dr. Daniel Harris applied to 67 general surgery residencies and landed eight interviews at residency programs. On the Monday before Match Day, he got an email letting him know that none had accepted him.Harris said he was in disbelief, but he didn’t have time to process that feeling. He had just two hours to decide which programs he would apply to through the Supplemental Offer and Acceptance Program, or SOAP, which helps unmatched applicants find open spots.Harris picked 20 programs and hit “submit.”“I maybe started crying at that point,” he said. “There was nothing more I could do.”Harris got lucky: He was one of 599 US medical school seniors who scooped up unfilled spots through SOAP last year. Other types of applicants — for instance, those from foreign schools — grabbed another 400-plus spots.That still left hundreds of seniors at US medical schools, and thousands from international schools, halted in their quest to practice medicine in the United States.Were they weeded out for good reason? That’s open for debate. Surely, some were ill-prepared. Others may have been unlucky or just played their cards wrong when picking which residencies to apply for.The most common reason for not matching is poor scores on national board exams, according to a 2005 survey by the AAMC. Other reasons include: applying to a specialty that’s too competitive for the applicant’s academic standing; poor interviewing or interpersonal skills; and having to take a board exam multiple times to pass.Some people in this situation, like Dr. Nick Milligan, decide not to pursue a medical license. Milligan graduated from St. George’s University School of Medicine, on the Caribbean island of Grenada, in 2014. He said he was disappointed not to match with a residency, but he ended up happily employed at Coachella Valley Volunteers in Medicine in California, where he has used his medical training to build a diabetes education program.Medical school grads face a staggering $183,000 in debt, on median, but they can seek relief, as Milligan does, from federal programs that limit monthly loan payments to 10 percent of income.Most graduates of US medical schools don’t give up on becoming a licensed doctor if they don’t match, said Geoffrey Young, AAMC’s senior director for student affairs and programs. They often spend a year doing research, or complete a fifth year of medical school, then apply to the match the following year.Related Story:An urgent call for diversity in medicine, ‘the profession I love’More than 99 percent of US medical school graduates do end up practicing medicine within six years of graduation, Young and coauthors found in a study published in JAMA.The new state laws might offer some of the unmatched students another route to a medical career.Missouri is expected to open enrollment for its assistant physician license this fall. Because it has the least restrictive rules, it may face a flood of applicants from around the country.Schmidt could be one of them.If Missouri opens the door for her to treat patients, she said, “I’d pack up and move in a second.”Update: The story has been updated to include statistics about the matching program for this year.Unmatched Graduate: “Med Schools to Blame”by SkepticalScalpel | Oct 17, 2016 | 30 commentsSkeptial Scalpel (click to view)The following was submitted as a series of comments on my Physician’s Weekly post about Missouri’s new law allowing medical school graduates who did not match into residency positions to work under supervision. The comments have been edited for length and clarity:I am a 38-year-old US medical graduate who has attempted to match 3 times with no success. I decided not to throw the money away again this cycle. I have half a million dollars in educational loans. I would exchange my situation with any non-US-IMG because they probably don’t have massive loans. I have seen kids coming fresh from India with no loans who match in their first attempts because they score high enough on USMLE to separate themselves from people like me.Based on USMLE scores, the matching system is fair to a lot of us. What fails US grads is the educational loan structure that allows us to borrow without any accountability of medical schools that are benefiting most. If medical schools are going to produce doctors who cannot match after genuine attempts, the schools should be blamed. They have standards that require students to pass each course in order to graduate. If they believe a student is not good enough to become a doctor, they shouldn’t graduate the student. Students would benefit more if the medical schools could determine which med students won’t be good doctors earlier on and dismiss them. Then the students will not pile up so much debt.Some graduates find that their training is not good enough to become a physician. It’s a scam. Why do medical schools get a free ride on this? Everyone who has completed medical school successfully with passing scores on USMLE Step 1 and 2 should be allowed to use that acquired knowledge. Why not let those who have demonstrated they can work under supervision get job?What fails US grads is the educational loan structure that allows us to borrow without any accountability of medical schools that are benefiting most.When I try to get a nonclinical job, they read my resume and tell me I am overqualified for the position. I have tried to hide my MD degree and use only my Bachelor of Science degree (biology) in order to get a job. But they tell me I don’t have experience, and the big gap between my undergrad education and my current situation cannot be explained. Some employers have asked me if I spent the time in jail.I applied to PA schools last year and had no success. Some of my rejection letters said as a medical doctor, I am not a good fit for PA career. Some PA programs wanted me to go back to college again to take pre-med courses.Besides medicine I have no other skills I can use to make a living. I am broke. I refuse to become homeless. Last month I applied and qualified for food stamps. Next week I am starting a $10.15/hour job as a UPS package handler while I am looking for other better opportunities.Each year about 5% of US graduates do not match to a residency and have nowhere to go. There are many reasons we did not match—most commonly because of academics. If I were a program director, I would interview the best applicants and rank them accordingly. I just believe unmatched doctors must be given other opportunities to make use of their acquired knowledge instead wasting it in a warehouse or a grocery store.If fresh college grads with 2 years in PA school can become providers under a licensed physician why can’t someone who made it through med school in 4 years function at the same level? Having an MD degree without a residency is like having a felony record. No one will give you a job. Having an MD degree without a residency dooms you to struggle in life. I wish I didn’t have the heavy weight of the MD degree on my back.I hope marginal pre-med students will read my story and make a rational decision before applying to medical school. Med schools want to fill their classes because they know the more students they have, the more money they will make. As they collect your tuition, they will tell you they are nonprofit institutions.No med schools will tell pre-med students the drawbacks such as the scarcity of postgraduate training as med school class sizes increased 30% since 2000. Most schools only publish lists of students who matched successfully and fail to mention those who don’t match. Pre-med students should be told what happens to all graduates of each med school.My story may not be relevant to pre-meds who have demonstrated great potential in medicine (GPA, MCAT, and motivation). The problem is some med schools can’t fill their classes with 100% smart kids. What they do instead is lower their standards to get more students to fill the class. Why? Because they want to make money and are not held accountable.If they can’t recruit students who can become licensed physicians in the US, the classes should be left unfilled. What is point of educating someone and giving him a piece of paper that can’t be used? These institutions should be held accountable for tuition and fees if a medical graduate attempts to match to complete his training but failed. This will force them to dismiss academically or professionally unfit students from medical schools before they accrue massive loans.I don’t see how the schools could ever be forced to do what the writer wants.Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.Foreign medical graduates get a raw deal. Here's why.ERIC BEAM, MD | EDUCATION | MAY 23, 2016On my recent tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs; not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school).Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even completed residency already in another country and were here to take a shot at becoming a U.S.-licensed physician, which would require them to do it all over again. To an outsider, they would appear as competitive candidates for programs that aspire to produce first-class doctors. But I did not envy their plight. In our conversations, one thing became clear: Whereas I was hoping to match into one of my top-choice programs, they were hoping to match, period. And, in 2016, only 50 percent did.FMGs get a raw deal. With the exception of Canada, we don’t recognize international medical training as meeting our quality standards; thus, doctors licensed to practice in their home countries must start at square one if they want to work here. Before they even apply to residency, FMGs need a stamp of approval from the Educational Commission for Foreign Medical Graduates (ECFMG). Only about half succeed in getting certified.One major hurdle, apart from the written exams, is the USMLE Step 2 Clinical Skills test, which requires a high-stakes demonstration of English proficiency and a costly trip to one of the five U.S. cities where it’s offered. (Interestingly, from 1998 to 2004 this test was called the Clinical Skills Assessment, and only FMGs were required to take it.) It’s virtually impossible for a FMG to start residency directly after finishing medical school. They’re often encouraged to do a few years of research to pad their résumé, or to do a rotation or two at a U.S. hospital. This adds up to a lot of time, money and effort spent on an endeavor that is far from a sure thing.All of this is not to say that we shouldn’t have a rigorous screening process for who we allow to train and practice here. We should, and we do. But we must acknowledge that the deck is stacked firmly against FMGs. Imagine you’re a program director comparing two applicants side-by-side, one a U.S. medical graduate and the other a FMG. If, on paper, the two appear to have equivalent qualifications, there’s a good chance the FMG worked harder and sacrificed more to get there. That is an achievement worthy of recognition.But these days it’s become something of a badge of honor for residency programs to exclude FMGs from their rosters, and historically they have served as “fillers” for residency spots that remain vacant after U.S. students have matched. In 1995, the Council on Graduate Medical Education, an advisory body tasked with making recommendations to the Department of Health and Human Services, singled out FMGs in their annual report and proposed cutting federal funding for their training by 75 percent in an effort to reverse course on an impending “physician surplus” (oh, the irony). They walked back this recommendation in a subsequent report due to anticipated “legal complexities,” but even their less controversial plan carried the same aim: to severely restrict FMGs from entering the physician workforce.I have heard two arguments for keeping FMGs out. The first is that their training is substandard. While I’m sure this applies to some cases, it is certainly not a universal truth. Is it really so hard to believe that a student whose education happens outside of a glittering first-world multi-million-dollar medical complex could learn the same principles of biomedical sciences as a student in this country? Is that student not examined as rigorously, mentored as thoughtfully, challenged as intensively, as one of ours?The second argument against FMGs is the so-called “brain drain” theory; that taking FMGs will siphon much-needed talent from poorer countries where doctors are scarce. I take particular issue with this one. All people, no matter their provenance, should be allowed to use their gifts to better their own lives, especially if that means escaping poverty or conflict.And let’s be honest: When a program director rejects a FMG, is he really thinking about the physician supply in Pakistan? What if we applied the same logic within our borders? If a medical student in physician-poor Arkansas graduates at the top of her class, with all the attendant publications and honors to her name, and wants to train at Massachusetts General Hospital, we don’t say, “No, you have to stay, Arkansas needs you.” We let her go as far as her talent and ambition will take her. Will Arkansas suffer? Minimally, perhaps, but they’ll be OK.The U.S. prides itself on having the best doctors in the world, so why not bolster our ranks by welcoming some of the best students the world has to offer? It’s curious that diversity is championed in medical school and residency admissions, just not this kind of diversity. Our knee-jerk aversion to FMGs seems to be the last true sanctioned form of admissions discrimination. First, we must ask ourselves if we want our admissions process to be truly merit-based. If the answer is yes, then it’s time to start recognizing merit even when it comes from outside our borders.Eric Beam is an internal medicine resident who blogs at the Long White Coat.Image credit: Shutterstock.com