What the Early 2013 Match Day Numbers Tell Us About Where We’re Going

After the mayhem and jubilation of celebrating a successful match at the Pritzker School of Medicine with our students, I went onto Twitter to follow the #match2013 hashtag to understand what the reactions were. Most were positive, but one headline caught my attention ‘In Record-Setting ‘Match Day,’ 1,100 Medical Students Don’t Find Residencies.”

It is true this was the largest match because it was “All-in” – programs either were in the match for all their positions (including international medical graduates or IMGs) or they were not. Obviously, many programs put more positions up for grabs in the Match. After I reposted this article to Twitter, there were many theories and questions about who these unmatched students were and why – some of which I have tried to answer to the best of my ability below. I welcome your input as well.

Who are these unmatched students? Why didn’t they match?

-Are these IMGs? This number is US Senior medical students who have been admitted and graduated from US medical schools but now have no place to go to practice medicine.

-Does this include those that entered the “scramble” now called SOAP. Technically, those that entered SOAP and were successful would have been counted as “matched” on Friday. Last year, 815 Us seniors went unmatched after the SOAP.

-Did they choose to go into competitive specialties? We have to wait for the 2013 NRMP statistics, which will likely address this. The 2012 data shows that more unmatched seniors did choose to go into competitive fields. Last year, the % unmatched is much higher for students applying to radiation oncology, dermatology, and competitive surgical fields for example.

-Did they go unmatched to due to poor strategy or poor academic performance? While poor strategy such as ‘suicide’ ranking only one program is related to the risk of going unmatched, the truth is getting into residency is competitive and there are some who will not match because of poor academic performance. Some even argue that medical schools have little incentive to fail students and a portion of these students should not be graduating to begin with.

-If they had gone into primary care, would they would have matched? I hear this myth that program directors in primary care fields only take international medical graduates (IMGs) since not enough US medical graduates apply. This is due to the largely untested assumption that any US Senior would be preferred to an IMG. However, I personally know program directors who would definitely take a seasoned and high performing IMG over a below-average US Student. The reason this is important is the rationale for not lifting the GME cap is that we have 50% of certain fields filled by IMGs and those spots would naturally be filled by US grads. Interestingly, many of these spots happen to be primary care driven fields. Yet, it is still unclear if US Seniors will displace IMGs for spots in IMG oriented residencies. It is also unclear if they will be willing to apply to programs that typically cater to IMGs, since they are often not considered as prestigious or geographically desirable to US students.

-Is this related to the lack of GME spots? Certainly, it is true that more effective career advising may have resulted in applicants being more strategic about their rank list and not reaching for a competitive field. However, we cannot ignore the supply/demand side of this equation. At a time when there is a shortage of physicians and a call to increase the number of physicians, the US medical school system by responded to this call. New medical schools have opened. Existing medical schools have increased their enrollments. So, there are now more US Seniors entering the match and there will be even more in the future as new medical schools mature their entering classes to graduating students over the next four years. Given that the supply of matched candidates includes both foreign-born IMGs and US-born IMGs, there are more candidates than spots. And while many believe IMGs will be the ones that get “squeezed out” in this shortage situation, again this is an untested assumption. It is also important to recognize that IMGs often play a significant role in ensuring primary care for rural populations and underserved communities,which are often not geographically desirable by US graduates.

The Bottom Line

We are left with a fundamental question: Do we owe it to our entering medical students who successfully graduate from medical school to have a residency spot? At a time when we have a shortage of physicians and a call for medical schools to increase in size, should we not expand our residencies? Unfortunately, GME funding is on the chopping block because of the belief that too much money is being wasted on residency training. Moreover, hospitals seem less enthusiastic about expanding residencies, as it is not as much of a bargain due to caps on hours residents work, and all the other new accreditation standards for residency training.

There is a potential solution. The “Training Tomorrow’s Doctors Today Act” by Reps. Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.), and the “Resident Physician Shortage Reduction Act of 2013” sponsored by Sens. Bill Nelson (D-Fla.), Charles Schumer (D-N.Y.), and Majority Leader Harry Reid (D-Nev.) would enable training 15,000 more physicians over 5 years. Moreover, spots would be distributed to programs and specialties in critical shortages, like primary care.

Given the time that it takes to train a physician, now is the time to act to ensure we have the doctors we need for the future.

Vineet Arora, MD, MPP is an Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. She blogs regularly at FutureDocs, where this post originally appeared.

17 replies »

  1. Exactly!!!! My loan amount is about $500/month (that is because my parents paid lot of my school out of pocket). Now both my parents are ill, one being tested for potential malignancy as I speak. They both took early retirements because their health won’t allow them to work anymore. I have been applying to 20 jobs per day (most require less than my good for nothing MD degree) and nothing yet! They say I can’t file for bankruptcy because its a student loan. Everyday I have to remind myself to not fall into depression but the reality that my retired parents salary goes to my loan payment tears me apart

  2. Then why don’t those with your mentality get together and start requesting these medical schools to cut down on number of students accepted each year into their program. Let them know now that people like you feel “OBLIGATED” to teach those in training and you rather worry about money alone. That way so many dreams don’t have to be crushed from the beginning. Alluring students into medical school with no definite future because few people who have made it rather not put in extra hours…..sounds pretty petty and downright selfish and careless

  3. I am one of those unfortunate FMGs. I am now looking at my options to file for bankruptcy since I can’t afford my student loans and I will probably never have a medical residency. US failed to take care of their own!!!!

  4. To Sebastian: It’s not so much about “physicians demanding jobs from the taxpayers,” it’s about physicians wanting to complete their training. Medicine is the only terminal degree that will not allow that person to directly seek employment. With lawyers, architects, nurses, etc., you can get a job the day after you graduate from school. What is happening here is all of those US medical grads cannot complete their training, so they will sit around and hope to match next year (meanwhile, they will have to start repaying an astonishing sum of loan money). After trainees complete the residency and become “real” doctors, they do not demand jobs and have to job hunt just like everybody else.

  5. Does anyone try to determine how many docs are needed? If so what are the figures – population per doc, sick people per doc?

  6. Residency is still part of physician training. One is unable to practice medicine in the United States without at least one year of residency, thus these have incurred approximately 200,000 dollars in debt and are unable to even look for another job within medicine.

  7. It’d be nice if they limited the lawyer supply (excluding Public Defenders).

  8. Thanks for your comments and interest.

    Whats different about physicians from some of these other professions is that in order to practice you must enter a residency for which the largest payer is the federal government through Medicare. The number of residency spots is also limited by federal legislation,and is not able to respond to market forces like other professions. With the ACA, everyone will get some basic healthcare insurance so they can access healthcare. While the demand for physicians will go up, the supply cannot “reset” itself without government intervention.

    The NRMP (National Resident Matching Program) will publish their match data soon and will answer some of the questions that remain – unfilled spots, specialty of those who went unmatched etc.

  9. Let me put in another way: Why would a physician want the federal government to decide how many physicians are needed? They don’t decide how many architects, etc., are needed.

  10. @ Sebastien – where did you get the idea that they do?

    And why the hell are you opposed to them figuring out where they should go and what they should be studying ?

    Are you picketing architects meetings too?

    Y’all have fun with that, bubba

  11. Why do physicians uniquely (as a profession) believe that the taxpayers’ owe them employment after their studies? I don’t see lawyers, engineers, or architects demanding the same.

  12. Saw this mentioned on Twitter earlier (re hashtag #Match2013). Subsequently cited it on my REC blog.

  13. I work at one of those places that just started a medical school. We have been asked if we would like to start a residency (anesthesia). We do not. It is an incredible time commitment with little compensation. We already face a lot of pressure to cut costs. Work days are long already. Adding residents would just make this worse. We already train medical students from there different schools and residents from other areas. I seldom get to do a case w/o a trainee of some sort in the room. For the most part, it works out. We do our part to train people, recognizing that it is an obligation we have to our institution, and when you get a good, interested student/resident it is actually fun and challenging. But, since I am the corporate money guy, I dont see the finances of residency working out.