The hardest part about not matching into residency is finding a way to practice medicine.

You are in a “limbo” period – you have the medical degree you’ve worked your entire life to get, but you haven’t completed the compulsory training you so desperately need to obtain a license to practice.

So what can you do?

You can work as a medical assistant, research assistant, or find an observership where you are limited and do far less than what you did in your 3rd year of medical school. Essentially, you work without pay hoping this will boost your CV before reapplying for residency again the next year. But the reality is, your chances get lower every year away from medical school graduation, and 25% of applicants (meaning about 10,000 individuals) will not obtain a residency each year.

What a lot of people don’t know is there is another option that is far better, and much more practical, to the skill sets of a doctor.

I had the opportunity to get my license as an Assistant Physician in Missouri and worked at both an Urgent Care and Primary Care center.

The scope of practice is under the supervision of board-certified physician and can be equated to the level of a Nurse Practitioner or Physician Assistant. I took histories, completed physical examinations, wrote/signed medical notes, did procedures, and prescribed. I was managing patients with UTIs and strep throat to those with chest pain and even COVID-19.

For the first time since graduating medical school, I was practicing medicine. And it has been the most rewarding and amazing opportunity that I have ever stumbled upon.

The particular Urgent Care I worked at had you go through a 3 day shadow and interview process before acceptance. Then you had 120 hours of training before you were allowed to take on shifts, varying between two locations, both day and night shifts. We had weekly didactics and case presentations to support our learning as we would in residency training. The clinics were also the only ones open 24/7 in the St. Louis area and a lot of patients would opt to be seen here rather than wait for hours in the Emergency Department.

The Primary Care clinic I volunteered at had us taking care of patients with more complex conditions such as uncontrolled diabetes and hypertension, many who did not have appropriate medical care or even insurance. Our supervising physician also provided residency prep, like proofreading our personal statements and conducting mock residency interviews.

While the experience was not exactly equal to the rigor or breadth of residency, it gave me a chance to care for patients, particularly in underserved and rural communities.

It also giving me opportunity that enhanced my residency application and connected me with physicians that not only wrote strong LORs, but advocated on my behalf.

The most important thing for me, is that is proved that I wasn’t a complete failure. When repetitively going through the residency application process, being denied because of the sheer volume of applicants, you lose your sense of worth. You start to believe you are the failure, but in reality we have a system that is failing the future generation of doctors.

Now one of the big questions – how do you get licensed?

The eligibility requirements for this type of license is equivalent to that of residency: Graduate medical school in good standing, completion of USMLE steps 1 and 2, ECFMG certification for International Medical Graduates (IMGs), and have not completed residency training. A few states have other requirements such as completion of Step 3, proof of residence in that state, graduation from specific medical schools, or confirmation of employment prior to licensure. You simply fill out the form, obtain the required documents, and send it to the board for approval. It can take anywhere from a few days to a few months, depending on the state applied to.

These are the states that currently license physicians to work under supervision without requiring a residency:

1. Missouri
2. Arizona
3. Florida
4. Washington
5. Arkansas
6. Utah

Due to the ongoing COVID-19 pandemic, several states have also issued temporary licenses to physicians without requiring a residency.

Illinois and New York are just two examples, but they unfortunately expired recently. More states have grassroot efforts to bring these type of licenses to their states, but it has been an uphill battle. While there is momentum in medical graduates applying for licensure, finding a collaborative physician to practice with makes it difficult to utilize the license. Not to mention, few opportunities which are paid, making it difficult for medical graduates to make a decent living, pay of the burden of student loans, as well as save up for the costs of residency applications.

Licensing medical graduates would provide an innovative pathway for practice and allow practicing physicians to support the next generation of doctors by bridging the gap for those struggling between medical school and residency.

Resources

1. COVID-19 Temp Licensing by state: https://licensing.csg.org/covid-policy-responses/temporary-licensure/
2. Missouri Assistant Physician: https://pr.mo.gov/boards/healingarts/375-1002.pdf
3. Arizona Transitional Training Permit: https://azmbfileblob.blob.core.windows.net/azmd/MD_202111161445_37be675dc72e445fb5e610984873f74b.pdf?sv=2019-12-12&ss=bf&srt=sco&sp=rx&se=2031-01-01T03:00:00Z&st=2020-10-16T15:00:00Z&spr=https&sig=DZ6kk7nb6zpFJW1mchdxMtcPNH7fdLq17fijyG1few8%3D
4. Florida House Physician: https://flboardofmedicine.gov/licensing/resident-physicians-interns-fellows-and-house-physicians/
5. Washington MD-CE: https://wmc.wa.gov/licensing/applications-and-forms/international-medical-graduates-clinical-experience-license
6. Arkansas Graduate Registered Physician: https://www.armedicalboard.org/Professionals/pdf/GRP_AppPack.pdf
7. Utah Associate Physician: https://dopl.utah.gov/md/restricted_assoc_md_application.pdf