A record number of seniors at American medical schools tore open envelopes on Friday, hoping to learn where they’ll spend the next several years training as doctors, but for more than 1,000 of them, Match Day was a crushing disappointment.
Some 1,097 of them went unmatched this year, up from 850 last year. That worries the head of the Association of American Medical Colleges, who said it demonstrated the need to lift a cap on Medicare-supported residency slots that has been in place since 2007.
“Match Day is usually a day of excitement, enthusiasm, and joy for medical students around the country,” Darrell G. Kirch, president of the AAMC, said in a written statement on Friday. “While that remains true for most graduating medical students, we are very troubled by reports about significant numbers of highly qualified U.S. medical-school graduates who did not match to residency-training positions.”
This year’s was the largest match since the program began, in 1952, with more than 40,000 applicants registered. Four new medical schools graduated their inaugural classes this year, and existing medical schools expanded their enrollments.
Among the bright spots, the number of American students choosing residencies in primary care—internal medicine, family medicine, and pediatrics—increased by nearly 400 this year.
Seniors at allopathic medical schools, which grant M.D. degrees, made up 16,390 of the 25,463 applicants who successfully matched to first-year residency positions. The rest were students and graduates of osteopathic schools, which grant D.O.'s, American citizens who attend or graduated from international medical schools, and citizens of other countries at international medical schools.
The National Resident Matching Program uses a computerized algorithm to pair the preferences of applicants and residency programs as closely as possible, based on rank-order lists each submits. Students who were not matched on Friday can try to secure one of the unfilled positions.
Sponsors of the matching program include the medical-colleges association, the American Medical Association, and the American Hospital Association.
‘I Can Never Repay Them’
Among those celebrating were students of the University of Central Florida’s College of Medicine, which opened in 2009. Unlike the typical medical-school graduate, who leaves with more than $160,000 in debt, Central Florida’s entire class received full, four-year scholarships covering tuition, fees, and living expenses. The scholarships were provided by donations from doctors, hospitals, businesses, and local philanthropists.
Right at noon, Will Kang asked the donors who had covered his $160,000 in expenses to open the envelope, dangling from the ceiling of a medical-school atrium, for him.
He got his first choice: an orthopedic-surgery residency at the Ochsner Clinic, in New Orleans. “I wanted them to open it because they’ve become like surrogate parents to me. I can never repay them,” he said of Judy and David Albertson, of Orlando, Fla.
The matching program was able to offer some 2,399 more training positions this year by requiring teaching hospitals to fill all of their residencies through the match, rather than letting them offer some positions directly to trainees.
The match was created to eliminate the pressure some teaching hospitals were putting on medical students to accept offers right away, before they had had a chance to weigh others. But while offers to American students have had to go through the match, hospitals have been permitted in the past to offer positions directly to applicants from osteopathic schools and overseas medical schools. Some lower-ranked hospitals, fearing they would not be competitive in the match, have done so.
The new policy resulted in more matches for applicants from foreign medical schools and from osteopathic schools. The group that typically gets first dibs on the most coveted spots—students and graduates of M.D.-granting medical schools in the United States—saw their match rates slip slightly, from 95.1 percent last year to 93.7 percent this year.
Competition for Plastic Surgery
Mona M. Signer, executive director of the matching program, said there was no need for alarm. “There are, with the exception of very few specialities, enough positions for U.S. seniors to fill,” she said. Orthopedic and plastic surgery and dermatology remained among the most competitive specialties. Primary-care slots were among the easiest to snag.
But competition across the board could get stiffer if the cap on Medicare-supported residency slots isn’t lifted, the medical-colleges group noted.
The association predicts a shortage of more than 90,000 physicians by 2020 as baby boomers age, doctors retire, and, with health-care reform, 32 million more people have health insurance.
The associations representing both M.D.- and D.O.-producing medical schools are supporting legislation, introduced on Thursday, that would increase the number of Medicare-supported residency positions by 15,000 over five years.
The legislation, HR 1201, sponsored by Rep. Aaron Schock, an Illinois Republican, and Rep. Allyson Y. Schwartz, a Pennsylvania Democrat, would give priority to hospitals in states with new medical schools and would emphasize training in community-based settings. Hospitals would be required to train at least 30 percent of their residents in primary care and general surgery—two areas with projected shortages.
Osteopathic schools held their own match ceremony in February, with 11 percent more applicants matching in family-practice residencies, the most popular choice, than last year. Students at those schools can participate in either match.
