Living The (Im)Possible Dream: Dr. Faarina Khan
To dream the impossible dream... To fight the unbeatable foe. To bear with unbearable sorrow... To run where the brave dare not go. To right, the un-rightable wrong... To love pure and chaste from afar. To try when your arms are too weary... To reach the unreachable star. This is my quest, to follow that star... No matter how hopeless, no matter how far. To fight for the right without question or pause... To be willing to march into hell for a heavenly cause. And I know if I'll only be true to this glorious quest... That my heart will lie peaceful and calm. LYRICS by Andy Williams, "The Impossible Dream"
In all other instances of professional careers requiring higher levels of education, an individual is ready to begin working after obtaining their degree and completing any necessary licensing/proficiency exams. Medical school graduates who wish to practice in the US, on the other hand, have to apply to hospitals to join their postgraduate medical training (also known as “residency”) programs. It is impossible to get a license to practice medicine in any U.S. state or territory without at least a year of residency training from an ACGME (Accreditation Council for Graduate Medical Education) accredited program; most states require full completion of a residency program.
Unfortunately, there are more residency applicants than available residency positions; in the most recent NRMP Match cycle that concluded in March 2022, for example, 47,675 total applicants applied for 36,277 PGY-1 positions with a total of 13,600 applicants remaining unmatched afterward (since not all positions were filled during the main Match.) This represents about 29% of all applicants going unmatched. I have been applying to residency programs ever since I graduated from a Pakistani medical school in 2015, ranging from applying to only 75 programs locally in 2016 to 386 across the entire country in 2020; just the application fees alone cumulatively cost me around $30,000 over that whole time frame.
Pursuing medical studies overseas seemed like a great idea initially since a medical education abroad is much less expensive than it is in the U.S. without compromising on the quality of training. However, I never had a clue and could therefore not have anticipated the enormous barriers that foreign-trained doctors face. Said barriers come at a price: America is said to have a doctor shortage (particularly prominent in rural and underserved communities) that will grow to about 122,000 physicians by 2032.
Tapping into the talents of underutilized foreign-trained doctors would help solve the problem since there are tens of thousands of international medical graduates in the U.S. cumulatively who have not matched into residency. After having tried my hand at being a medical assistant, research assistant and pursuing a Master’s in Public Health degree, I finally came across the opportunity that changed my life: working as a licensed assistant physician.
This special license in the state of Missouri allows medical school graduates who meet certain eligibility criteria to work under the supervision of a fully licensed physician in medically underserved areas within specific primary care specialties (internal medicine, family medicine, pediatrics, OB-GYN and addiction medicine). With this license, I joined a non-profit charity family medicine clinic in Grandview, Missouri, known as The Medina Clinic. I saw up to 8 patients daily who were typically uninsured and members of vulnerable populations (mainly unemployed and immigrant/minority), prescribed routine maintenance medications, ordered lab work and diagnostic imaging, generated specialist referrals, and performed minor outpatient procedures (such as cerumen disimpaction, suturing and stitch removal) from June 2018 to May 2021. In my last year at The Medina Clinic, I was promoted to being the chief assistant physician; this entailed helping with recruitment and onboarding, provider scheduling, re-establishing telehealth services, being a liaison between the physician and the other APs and addressing general troubleshooting. One of the signature moments during the COVID-19 pandemic came when governors from New York and New Jersey put out a call for health practitioners across the country to travel to their states to help early on during the outbreak. I applied to these and other states on the basis of my AP license but despite the dire need, I and many of my assistant physician colleagues were turned away. We were told that our licensure had no equivalent in their state, so we were not eligible for temporary reciprocal out-of-state licensure.
Our experience was different in Missouri, however. Since our assistant physician licenses were issued by this state’s medical board, the governor specifically allowed assistant physicians to help with COVID-19 efforts. The main avenue for this was with Missouri’s Disaster Medical Assistance Team (MO-1 DMAT), which I joined in April 2020. That experience had many of us foreign-trained doctors feeling that our skills and our efforts were finally being seen and appreciated as we worked alongside nurses, physician assistants, paramedics, EMTs and other healthcare professionals.
My journey took a turn for the best because I successfully matched into the Roseburg Family Medicine Residency program in Roseburg, Oregon, as of March 2021. However, there is absolutely no way that would have happened had it not been for my assistant physician experience. Additionally, it prepared me well for residency in several ways. Being trained to complete my charting within 24 hours was on par with expectations for completion of inpatient charting and more stringent than the 72 hours for completion of outpatient charting in residency. Having to check my Practice Fusion EMR inbox daily to address all messages and concerns made it easy to stay on top of my Athena EMR inbox daily in residency. The process of seeing the patient yourself first, then presenting to the attending, and then going back in to finalize the plan was implemented at my clinic so I was already comfortable with the basic workflow when I started my outpatient continuity clinic. Compared to my co-interns who were fresh medical school graduates, my adjustment/learning curve on the outpatient side was therefore much less steep.
It is my understanding that many if not all of my assistant physician colleagues (both from my clinic and elsewhere) had similar experiences with their transition to residency. I want the public to better understand the struggles I went through and that thousands around the country continue to face. I want fully licensed physicians to allow those unmatched graduates to have a chance at the same outcome. And I want those who successfully overcame the obstacle to join me in empowering our colleagues. Because at the end of the day, there should be fewer barriers and more support in trying to decrease the physician shortage and increase access to equitable quality healthcare in ALL settings for ALL patients.
*NRMP 2022 Main Match Results Report
Ahmed H, Carmody JB. On the Looming Physician Shortage and Strategic Expansion of Graduate Medical Education. Cureus. 2020 Jul 15;12(7):e9216. doi: 10.7759/cureus.9216. PMID: 32821567; PMCID: PMC7430533