This fall, a record number of students began medical school, while a record number of medical students failed to match into a specialty. With more medical students vying for residency positions, many students are facing the possibility of not matching into their chosen specialty. A basic understanding of The Match—and its risks—is important for anyone going into medical school.
The residency match program began in 1952 as a way to provide a single clearinghouse for medical residency positions. Using an algorithm, the match program allows candidates and programs to rank each other, then attempts to match applicants to their highest ranked programs, while also working to fill every position. The first match included 6,000 applicants and 10,400 positions. In 2013, 40,335 applicants applied for 26,392 PGY-1 positions. Of these applicants, 17,487 were US Allopathic students (1). The rest of the applicants are osteopathic students and international students, both US and non-US residents.
In 2006, the Association of American Medical Colleges began approving new medical schools across the country, adding seventeen new schools with seven more coming in the near future. These new schools, and expansion of class sizes at other schools, has led to a 30% increase in enrollment since 2006 (2). While the AAMC has been increasing medical school numbers, the residency positions have not increased. Unlike medical student spots, residency positions are controlled both by available funding and approval by private organizations, called Residency Review Committees (RRCs). Residency positions are approved by RRCs for each specialty, and the vast majority are funded by Medicare funding through Direct Medical Education (DME) payments (3). Since 1996, medicare funding for residencies has remained frozen, preventing any viable expansion of residency positions, since it costs approximately $145,000 a year to train a new resident (4). Although some hospitals have begun funding their own residency positions, this is a difficult and expensive proposition for most organizations.
So what does this mean for students currently entering medical school? Although the vast majority of US allopathic medical students will still match, roughly 500 each year will find themselves unmatched. In 2013, 17,487 US allopathic students matched at a rate of 93.7%, so the odds are still on your side. The growing competition from international medical students, osteopathic students, and US students who train overseas, along with a growing allopathic class size, means more students will find themselves unmatched each year. Until more residency positions are made available, the most important take away is that students must become increasingly competitive to secure their chosen specialty.
(1) “Results and Data; 2013 Main Residency Match.” NRMP. 1 Jan. 2013. Web. 23 Nov. 2014
(2) Doctor Shortage May Swell to 130,000 With Cap
(3) Nicholson, Sean. “Barriers to Entering Medical Specialties.” NATIONAL BUREAU OF ECONOMIC RESEARCH 1 Jan. 2003. Web. 23 Nov. 2014.
(4) Innovative funding opens new residency slots
By Evan Kuhl, a fourth-year medical student wanting to match in emergency medicine. Evan is interested in the intersection of sports and medicine, and is an avid cyclist. His website, www.evankuhl.com, includes helpful tips for pre-med and current medical students.