Residency Match Day Grows Again, Hitting New High This Year

Marcia Frellick

March 16, 2018

The National Resident Matching Program (NRMP) announced today that the 2018 Main Residency Match is the largest yet, with a record 37,103 US and international applicants listing program choices for 33,167 positions.

The number of first-year (PGY-1) positions increased by 1383 from last year and now stands at 30,232.

Of those 30,232 positions, nearly half (14,695) were in primary care: family medicine; internal medicine; internal medicine–pediatrics; internal medicine–primary; and pediatrics.

Within the primary care slots, 14,333 (97.5%) were filled, and 7104 (48.3%) were filled by US allopathic seniors. Since 2014, the number of primary care positions has grown by 1713, or 13.2%. The following is the breakdown of primary care highlights from 2018.

Table. Primary Care

Program No. of Positions Increase Over 2017  No. of Positions Filled (%) No. of Positions Filled by Allopathic Medical School Seniors (%)
Internal medicine 7542 309 7363 (97.6) 3195 (42.4)
Family medicine 3629 273 3510 (96.7) 1628 (44.9)
Pediatrics 2768 30 2711 (97.9) 1746 (63.1)


Signs of Most Competitive Specialties

Signs of the competitiveness of specialties are the percentage of spots filled and the percentage filled by allopathic medical school seniors.

"The ones that fill at least 90% with US allopathic seniors are the ones we say are very competitive," Mona Signer, president and CEO of the NRMP, told Medscape Medical News.

This year, the specialties for which more than 30 positions were available and that filled all available positions (with a combination of allopathic and osteopathic students) were integrated interventional radiology, neurologic surgery, physical medicine and rehabilitation, and thoracic surgery.

The specialties with more than 30 spots that filled more than 90% with US allopathic seniors were integrated interventional radiology, orthopedic surgery, integrated plastic surgery, radiation oncology, neurologic surgery, and otolaryngology.

In internal medicine, both the number and percentage of US allopathic seniors matching have declined every year since 2015; in pediatrics, the percentage of US allopathic seniors matching has declined since then.

"What is interesting about this is that more US seniors now are matching to family medicine," Signer said. "The number has increased every year since 2009."

Overall, the most competitive and least competitive specialties haven't changed for many years, Signer said.

More DOs in Match

Signer said that this year, the Match saw a significant increase in students and graduates of osteopathic medical schools.

The numbers of DO medical school students and graduate students who applied were 4617 and 3771, respectively, and 81.7% matched to a first-year position. Both are all-time highs.

According to the NRMP, since 2014, the number of osteopathic medical school students and graduates applying in the Match has risen by 1879 (68.6%).

There are two reasons for that, Signer said. One is that enrollment in DO schools is increasing, as reported by Medscape Medical News. The number of DO students has increased 85% over the past 10 years. The other is that DOs and MDs are moving toward a single accreditation system, and more DOs are migrating into the Match. By 2020, all graduate medical education programs will be accredited by the Accreditation Council for Graduate Medical Education, and the American Osteopathic Association (AOA) Match will end.

"As more and more positions are in the NRMP and fewer positions are in the AOA Match, the applicants are being drawn to the NRMP," Signer said.

International Medical Graduates

The number of non-US-citizen international medical school graduates (IMGs) who participated in the Match decreased for the second year in a row.

This year, 7067 IMGs submitted program choices, down 217 from 2017 and 393 from 2016; 3962 IMGs (56.1%) matched to first-year positions.

"We suspect that that is because of concerns about the administration's immigration restrictions," Signer said.

"On the other hand, for both US-citizen and non-US-citizen IMGs, their match rate was the highest in 25 years," she said.

Many of the positions that don't match are PGY-1-only positions, and again this year, many of those are in preliminary surgery, Signer said. Those are positions that don't lead to specialty training. A preliminary surgery position offers only 1 year of training, so "it becomes a dead end unless you can get training beyond that 1 year," Signer said.

Even with the increases in both osteopathic and allopathic matches, a physician shortage is worsening. Solutions require a reversal of trends on many fronts, says the Association of American Medical Colleges (AAMC).

A 2017 study conducted for the AAMC by IHS Inc predicts that the United States will be short from between 40,800 to 104,900 physicians by 2030. There will be shortages in both primary and specialty care, but specialty shortages will be particularly severe, the report shows.

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