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Updated: 23 min 35 sec ago

Two Unmatched-Doctor Advocacy Groups Are Tied to Anti-Immigrant Organizations

April 30, 2021

In their last year of medical school, fourth-year students get matched to a hospital where they will serve their residency.

This story also ran on The Daily Beast. It can be republished for free.

The annual rite of passage is called the National Resident Matching Program. To the students, it’s simply the Match.

Except not every medical student is successful. While tens of thousands do land a residency slot every year, thousands others don’t.

Those “unmatched” students are usually left scrambling to figure out their next steps, since newly graduated doctors who don’t complete a residency program cannot receive their license to practice medicine.

At first glance, two new advocacy groups, Doctors Without Jobs and Unmatched and Unemployed Doctors of America, seem to be championing their cause, helping them find residency slots and lobbying Congress to create more medical residency positions. The groups also recently organized a protest in Washington, D.C., to draw attention to the scarcity of residencies.

But the organizations aren’t merely support groups. They are tied to Progressives for Immigration Reform, an organization that the Southern Poverty Law Center has designated as an anti-immigrant group. PFIR is financed by an anti-immigrant foundation and its executive director has been affiliated with a network of anti-immigrant groups.

The two doctor groups want U.S.-trained and U.S. citizen doctors to get top priority in the Match over foreign-educated doctors. While both Doctors Without Jobs and Unmatched and Unemployed Doctors of America do not say they are anti-immigrant, their websites include messaging that implies foreign doctors are taking residency spots away from U.S. doctors.

We need long-term solutions to the unmatched MD issue. That could include a 25 percent reduction in the number of doctors admitted on H-1B and J-1 visas.

— Doctors Without Jobs (@DocsWithoutJobs) March 17, 2021

However, newly unmatched medical students searching for a source of support aren’t necessarily aware of the groups’ anti-immigrant affiliations.

Haley Canoles, a fourth-year medical student who didn’t match this year, was caught off guard when she learned of the organizations’ deeper agenda.

“I had no idea. I just recently joined Twitter and started following groups that I thought could help me network to find a residency position,” Canoles wrote in a private message on Twitter. “I absolutely do not stand for any anti-immigration agenda.”

As the percentage of unmatched U.S. medical students increases each year and the number of residency positions remains mostly static, more could be drawn to a support group such as Doctors Without Jobs.

According to 2021 data from the National Resident Matching Program, the percentage of medical school graduates who don’t match has increased. In 2021, 7.2% of students didn’t match into residency programs, up from 5.7% in 2017.

Meanwhile, the percentage of non-U.S. citizens who attended foreign medical schools who didn’t match has declined over the past five years to 45.2% in 2021, from 47.6% in 2017.

That makes advocates for international medical students worry that, if this trend continues, there could be increased resentment toward doctors educated abroad and xenophobic attitudes in the medical community.

“I obviously disagree with the idea that foreign medical graduates are taking spots from U.S. medical graduates,” said Dr. William Pinsky, president and chief executive officer of the Educational Commission for Foreign Medical Graduates, which certifies international medical graduates before they enter the U.S. graduate medical education system. “What residency directors primarily look for is who is the best qualified, and sometimes foreign medical graduates fit that bill.”

Kevin Lynn, executive director of PFIR, founded Doctors Without Jobs as an offshoot of the organization in 2018, after meeting an unmatched doctor outside a protest at the White House.

“I didn’t even know this was a problem, and then we started looking at the data and realizing that thousands of medical students weren’t getting into residency programs,” said Lynn. “At the same time, the number of foreign doctors who graduate from foreign medical schools and get taxpayer-funded residencies is increasing.”

PFIR endorses restricting immigration into the U.S., it says, to protect the American labor force and the environment. Its website also says it researches the “unintended consequences of mass migration.”

In a 2020 report, the SPLC found that Lynn had been closely involved with members of prominent Washington anti-immigration hate groups, including the Federation for American Immigration Reform (FAIR) and the Center for Immigration Studies (CIS). Both organizations push for reducing the number of immigrants in the U.S., are designated as hate groups by the SPLC and were founded by Dr. John Tanton, whom the SPLC has tied to white nationalists, racists and eugenicists.

And in July 2020, at the height of the covid pandemic, Lynn sent a letter to then-Senate Majority Leader Mitch McConnell asking him not to allow a bipartisan bill that would allocate unused green cards to foreign health care workers into the next covid stimulus bill, and instead prioritize unmatched U.S. doctors. That effort was publicized in Breitbart News, a right-wing publication that shares the anti-immigrant view. The bill died in the Senate.

The SPLC also reported that Joe Guzzardi, a writer for Doctors Without Jobs, has previously written more than 700 blog posts for a white nationalist hate website.

According to recent nonprofit filings, from 2015 to 2019 PFIR received almost $2 million in funding from the anti-immigrant Colcom Foundation, which also provides significant funds to FAIR and CIS. Neither Doctors Without Jobs nor Unmatched and Unemployed Doctors of America have made any public financial disclosures, though Doctors Without Jobs accepts donations.

The modus operandi of these types of nativist groups is to take any policy problem area and say the solution is to restrict or eliminate immigration into the U.S., said Eddie Bejarano, a research analyst at SPLC who wrote the 2020 report. Doctors not receiving residency spots is just the latest issue that the anti-immigration movement has seized on.

“They’re taking issues like this and saying that the solution is grounded in nativism, it’s not about reform,” said Bejarano. “It’s out of the textbook for nativists, if they can prey on the fears for normal Americans, such as here, where doctors are just wanting a fair shot at a job and blaming it on immigrants.”

Lynn’s rhetoric doesn’t contradict Bejarano’s observation. “I believe we should be prioritizing Americans,” Lynn said in an interview with KHN. “People say that is xenophobic, that is racist. These are attempts to quiet dissent. What I’m saying are uncomfortable truths.”

Unmatched and Unemployed Doctors of America has a less direct connection to the anti-immigrant groups. It claims it is solely volunteer-run, independent of Doctors Without Jobs and doesn’t receive any funding from the organization. But it does say on its website that it is affiliated with Doctors Without Jobs. The groups have worked together to organize a recent protest and feature each other on their respective websites and in promotional materials.

Leaders of Unmatched and Unemployed Doctors of America declined an interview but provided KHN with an emailed statement claiming nearly half its members are immigrants or are second-generation immigrants.

Doctors Without Jobs and Unmatched and Unemployed Doctors of America have increased their activity in the past couple of months. In January, members of the two groups traveled to Washington to protest outside the headquarters of the Association of American Medical Colleges, to bring attention to the issue of unmatched doctors. The AAMC runs the electronic system for submitting residency program applications.

The groups said they met with members of Congress to discuss reintroducing the Resident Physician Shortage Reduction Act, which would increase federally supported medical residency positions by 2,000 annually for seven years. The bill was introduced again in the House and Senate in March.

Doctors Without Jobs also recently released a video targeting the AAMC and saying that the organization is promoting a policy that “allows foreign medical students to take American students’ residencies.”

In an emailed statement, Karen Fisher, the AAMC’s chief public policy officer, said that any unnecessary restrictions on immigration would only accelerate and worsen the existing physician shortage and that foreign-trained doctors often fill critical gaps in the health care workforce.

“The nation’s teaching hospitals seek to recruit the most qualified candidates into their residency training programs,” said Fisher. “A blanket preference for U.S. applicants runs counter to this goal and would severely restrict the pool of highly qualified individuals and prevent U.S. patients from receiving the best possible care from a diverse and dedicated group of aspiring physicians.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

From Rotten Teeth to Advanced Cancer, Patients Feel the Effects of Treatment Delays

April 20, 2021

With medical visits picking up again among patients vaccinated against covid-19, health providers are starting to see the consequences of a year of pandemic-delayed preventive and emergency care as they find more advanced cancer and rotting and damaged teeth, among other ailments.

This story also ran on The Washington Post. It can be republished for free.

Dr. Brian Rah, chair of the cardiology department at Montana’s Billings Clinic, was confused in the early days of the covid pandemic. Why the sudden drop in heart attack patients at the Billings Clinic? And why did some who did come arrive hours after first feeling chest pains?

Two patients, both of whom suffered greater heart damage by delaying care, provided what came to be typical answers. One said he was afraid of contracting covid by going to the hospital. The other patient went to the emergency room in the morning, left after finding it too crowded, and then returned that night when he figured there would be fewer patients — and a lower risk of catching covid.

“For a heart attack patient, the first hour is known as the golden hour,” Rah said. After that, the likelihood of death or a lifelong reduction in activities and health increases, he said.

Dr. JP Valin, executive vice president and chief clinical officer at SCL Health of Colorado and Montana, said he is “kept awake at night” by delays in important medical tests. “People put off routine breast examinations, and there are going to be some cancers hiding that are not going to be identified, potentially delaying intervention,” he said.

Valin is also concerned that patients aren’t seeking timely treatment when suffering appendicitis symptoms like abdominal pain, fever and nausea. A burst appendix generally involves more risk and a week’s hospitalization, instead of one day of treatment for those who get care quickly, he said.

Dr. Fola May, a gastroenterologist who is also quality director and a health equity researcher at UCLA Health, worries about the consequences of an 80% to 90% drop in colonoscopies performed by the health system’s doctors during the first months of covid.

“All of a sudden we were downplaying health measures that are usually high-priority, such as trying to prevent diseases like cancer, to manage the pandemic,” May said.

Along with exacerbating existing health problems, the covid pandemic has also caused a host of new medical issues in patients. The American population will be coming out of the pandemic with teeth worn down from grinding, back problems from slouching at makeshift home-work stations and mental health problems from a combination of isolation and being too close to family.

Dr. Despina Markogiannakis, a dentist in Chevy Chase, Maryland, said patients don’t argue when she tells them they have been grinding or clenching their teeth and might require a root canal procedure, dental implant or night guard.

“These are people stuck at home all day and feeling lonely and feeling a little depression. It is induced by the world we live in and all the changes in our lives,” said Markogiannakis.

A recent American Dental Association survey found that more than 70% of member dentists reported an increase in patients grinding or clenching their teeth since covid. More than 60% reported an increase in other stress-related conditions, such as chipped and cracked teeth.

Dr. Gerard Mosby, a Detroit pediatrician, finds his young patients are suffering more stress, depression and weight gain than before the pandemic. They are confined in their homes, and many are living in multigenerational homes or foster homes or have experienced covid illnesses or death among family members.

“Since their ability to get out is limited, they can’t vent to friends or other family members. Also, most will not have access to mental health for grief counseling,” Mosby said.

Nancy Karim, a Bridgeport, Connecticut, licensed professional counselor and art therapist, said that, in addition to struggling with isolation, her patients are conversely stressed by living too closely with people without the benefit of breaks on work and school days.

Meanwhile, optometrist Matthew Jones, who practices in Blytheville and Osceola, Arkansas, reports worsening eye conditions for patients, some of whom stopped taking drops during covid for conditions like glaucoma. He’s also seeing much more eyestrain “because people are spending so much time in front of a computer screen” and recommends eyeglasses that filter out blue light to his patients.

Physical therapy needs are also on the rise.

“Patients that have transitioned to remote work are typically working with poor ergonomic set-ups and spending a lot more time sitting,” said Kaylee Smith, founder and president of Smith Physical Therapy and Performance Studio in San Diego.

“I am seeing more pain and injuries related to poor posture (i.e., neck pain, low back pain, etc.) and a significant increase in patients coming in with tight hips related to increased sitting time,” Smith said in an email.

Some providers report they are finally nearing pre-covid patient levels, but others still face covid resistance.

“Although we have seen an improvement over the past six weeks, it’s still not much,” said Neville Gupta of Gupta Gastro in Brooklyn and Far Rockaway, New York. “Our patients are still avoiding getting the care they need, no matter the safety precautions in place.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

UVA Health Will Wipe Out Tens of Thousands of Lawsuits Against Patients

April 20, 2021

University of Virginia Health System, which for years has sued thousands of patients annually for unpaid bills, said Monday it will cancel a massive backlog of court judgments and liens resulting from those lawsuits dating to the 1990s.

This story also ran on The Washington Post. It can be republished for free.

Combined with reforms UVA announced in 2019, the move is likely to benefit tens of thousands of families and make UVA Health’s collections policies much more generous than those of many hospital systems, said scholars who study health care finance. The decision to wipe out liens that can drain home equity years after a hospital visit is extremely rare, they said.

UVA had been suing patients for decades, many with unpaid bills in the tens or hundreds of thousands of dollars, KHN reported in 2019. Once the health system won cases in court, it could seize wages and the value of patient homes when they were sold. UVA limited its collections lawsuits after KHN’s investigation.

“This is very significant and a much-needed and overdue step,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing. “I don’t know if I’ve heard of that [lien abolition] happening anywhere else.”

But most families who have already surrendered money to UVA as a result of lawsuits or liens will not get their money back.

UVA will release all liens and judgments filed against all households making less than 400% of federal poverty guidelines, or $106,000 for a family of four, which should account for most of them, said Douglas Lischke, the system’s chief financial officer.

“This is a proud moment for us,” he said in an interview. “We want our financial care to be as good as our clinical care.”

“I am proud to see UVA Health System taking real steps to scale back aggressive medical collections and address the pain they’ve caused,” said Virginia Gov. Ralph Northam, a pediatric neurologist. 

Doris Hutchinson was surprised two years ago to find a UVA lien related to a relative’s bill on her mother’s Charlottesville, Virginia, home. The medical system demanded $39,000 from the family before the house could be sold. The money was placed in escrow.

Three weeks ago, she learned the judgment would be canceled and the money released.

“I’ll be excited about that,” said Hutchinson, who said she needs the funds to help pay for her grandchildren’s college education and replace income from her husband, who died two years ago. “I’m also happy for everybody else” who gets UVA bill relief, she said.

UVA will also stop blocking enrollment for university students with outstanding balances at the health system, university spokesperson Brian Coy said Monday. Keeping students from completing their education because they owed hospital bills was another practice revealed by KHN.

KHN reported in 2019 that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care. In response to the articles, the system suspended lawsuits against patients and wage garnishments, increased discounts for the uninsured and broadened financial assistance, including for cases dating to 2017.

The system named an advisory council of UVA officials and community leaders to consider permanent changes. The council delivered recommendations in October.

Like most hospitals, UVA wasn’t using property liens to foreclose on patients’ homes. But it was seizing money owed — plus 6% interest — from home equity when home sales went to settlement.

In response to KHN’s investigation, UVA said in 2019 it would improve financial assistance but continue to use the courts to recover money owed from families making more than 400% of the poverty threshold.

While unusual, UVA’s decision to substantially reduce lawsuits and erase liens stops short of moves recently made by VCU Health, its sister system based at another state university. VCU pledged to stop suing all patients and, in a process taking more than a year in courthouses across Virginia, is abolishing all old judgments and liens regardless of a family’s income.

“This seems like many steps in the right direction” for UVA, said Jenifer Bosco, an attorney at the National Consumer Law Center who specializes in health care. “There is always more that could be done. But providing assistance to families with income of up to 400% of the poverty level is a great step.”

The number of outstanding UVA Health judgments is unknown. For its part, VCU eventually found about 80,000 statewide. In Virginia, liens expire after 20 years, but UVA was taking the trouble to renew claims dating to the 1990s, KHN found.

Canceling them should take more than a year, Lischke said. UVA’s changes to billing and collections, including improvements to financial assistance announced in late 2019, will cost the system about $12 million a year, he said.

UVA’s move is far more beneficial to its patients and its region than other so-called community benefits that many nonprofit hospitals offer to justify their tax-exempt status, said Ge Bai, associate professor at Johns Hopkins Bloomberg School of Public Health.

Instead of testing services or medical education that are often hospital marketing campaigns in disguise, “this action is a concrete effort to relieve the financial burden of the community,” she said. “It also improves mental health. It relieves the stress.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).