SIOUX FALLS, S.D. (KELO) — Just because a student earns a medical degree, it doesn’t guarantee they will get to be a doctor.

Before a medical school graduate is a doctor, they must complete a residency program. Each year thousands of medical school graduates don’t get placed in a residency program. Medical officials said that isn’t because the graduates aren’t qualified; it’s because there aren’t enough residency slots. The American Medical Association (AMA) said there were 48,156 total applicants that had registered for 40,375 certified residency spots in March.

In 2022, 6.7% of the graduates of medical schools and 8.2% of the graduates of from DO schools did not match. That means thousands of graduates must wait or choose another path. That path could be medical research or some other medical field. Some end up leaving the field.

The numbers worry Dr. Lucio Margallo, president of the South Dakota State Medical Association and a specialist in internal medicine at Avera Queen of Peace in Mitchell.

In several years, the U.S. will be short about 130,000 medical providers, Margallo said.

There are not enough residency program slots to meet the need for future providers, he said.

The federal government has approved expanding the number of residency slots by 1,000, he said.

“Which is not enough,” Margallo said.

Based on the 2010 Census, the Robert Graham Center estimated that South Dakota will need 162 additional primary care doctors by 2030. KFF (a non-profit that focuses on national health issues) said in September the state needs 56 primary care doctors to remove a shortage designation.

The process of a student applying and being accepted for a residency program is called a match. Students must select a specialty field and generally, apply to residency programs at facilities and locations where they would like to work and live.

“The match has become more competitive. There are more students entering the match then there are positions,” Dr. Lori Hansen, the dean of medical student affairs at the Sanford School of Medicine at the University of South Dakota, said.

USD had 65 medical students apply for a residency match. “We are very fortunate that all of the students entering the match found positions in this year’s match,” Hansen said.

Margallo is pleased the students he worked with in Mitchell were matched with a residency program or accepted into medical school.

Hansen said 23%, or 15, of this year’s students, will stay in South Dakota for their residency. The states of Iowa, Wisconsin, Michigan and Nebraska have four students each, she said.

USD students have been successful but Margallo said the numbers are not enough to fill the need, including in rural areas of South Dakota.

The Rural Health Information Hub said that only four counties in South Dakota, Oglala Lakota, Yankton, Hughes and Lake are the counties without a primary care shortage.

Expanding the number of residency slots can help fill the need but it’s a complicated issue.

Medical systems willing to have residents must be accredited. The residents are paid during the multiple-year program and the reimbursement from the government may not be enough, Hansen said.

Funding, availability of preceptors (instructing doctors) and proper accreditation are challenges for medical systems interested in having residency programs, Margello said.

“Residency slots are very much dependent on the federal dollars (applied to them). That amount has been capped since the 1990s,” said Elizabeth Reiss, the director of communications for the SDSMA.

The number of residency slots has not kept up with the increase in the number of medical school students.

An increasing number of students have enrolled in medical school since 2012, according to the Association of American Medical Colleges (AAMC). The overall enrollment was 96,520 students in 2022-2023, which is an increase of 17.8% since 2012. The AAMC said a total of 22,712 students enrolled in 2022-2023.

In 2022, there were 47,675 registrants for the main residency match program, according to the National Residency Match Program (NRMP). That was a decrease of 1,025 from 2021. There were 39,205 positions offered.

According to Physicians Weekly, in 2021, 15,347 applicants were either unmatched, withdrew or submitted no rank list.

The shortage of residency slots is compounded by other issues that need to be addressed, Margallo said.

“If you take the medical (provider) shortage for the year 2025 at a 130,000 physician shortage, about 30% of those are medical school graduates like me,” Margallo said.

Margallo was not born in the U.S. and immigrated here to practice.

Changes are needed in the J-1 visa system and the Conrad-30 waiver program, Margallo said.

The J-1 visa allows international students to study and graduate in the U.S., but it needs to be expanded, Margallo said. The same with the Conrad-30 waiver program, which is geared toward placing doctors in underserved areas, which would include areas of South Dakota.

The SDSMA and the AMA support changes in the J-1 and Conrad-30 programs.

“If our immigration practice doesn’t change, where are you going to get that 30%,” Margallo said of the future need for doctors.

Adding to the already challenged doctor landscape is the age of today’s doctors and the growing U.S. population.

Doctors are aging, as 19% of all U.S. doctors were 60 to 69 in 2018, according to the AMA.

“The aging of physicians is a very important factor,” Margallo said.

The U.S. population is expected to increase to 370 million over the next several years, Margallo said.

The nation can’t afford to have medical school graduates potentially leave the field because they can’t get matched with a residency, he said.

“It’s a very frustrating deal,” Margallo said.

Some graduates may be able to fill a spot if another graduate leaves a residency.

Unmatched students can also participate in the Supplemental Offer and Acceptance Program (SOAP). Eligible unmatched applicants in the Main Residency Match apply for and are offered positions that were not filled in the first process.

Hansen said several USD graduates did need to choose a second specialty field to find a match after not finding a match in their first choice field. They chose a field and a placement site they knew they would be happy with, Hansen said.

Margallo also knows that some are “doing whatever work they can to survive.”

Graduates can apply the next year for a residency match.