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A Word From the President: Taking a Lesson from the 2013 Match

AAMC Reporter: June 2013

Last month, I had the honor of speaking at several medical school commencement ceremonies. When each student received his or her diploma, the program listing described where the student would complete his or her residency training. But something was different this year. For the first time in my nearly 20 years attending medical school graduations, for far too many students the program read, “Currently seeking a residency position.” It was heartbreaking to think of their plight.

When I graduated from medical school 36 years ago, the notion of not matching to a residency program was unthinkable. It is, however, the sad reality for hundreds of well-qualified medical school graduates this year. By the end of Match Week 2013, an unprecedented 528 U.S. M.D. seniors had not secured a residency training position—more than twice the number in 2012.

What happened? AAMC staff members have been investigating this question actively with student affairs deans, and we hosted a town hall discussion about unmatched students at the Careers in Medicine Professional Development Conference earlier this month in San Diego.

The most common reasons for students not matching, according to the feedback we received, revolve around the heightened competition that now exists for residency training positions. While medical schools have been expanding their class sizes to mitigate the coming physician shortage, the federal government has failed to fund its share of the costs of training additional residents. Since 1997, the Balanced Budget Act has capped the number of federally supported residency training positions, effectively putting a freeze on residency training.

As a result, more students simply were not competitive enough for their first-choice specialty in this year’s Match. Student affairs deans noted that some students did not rank a sufficient number of residency training programs or limited their rank order lists to highly competitive programs. Others cited a weak performance in interviews with residency programs as a reason that some students failed to match.

While there always are some students who do not match to a residency program, the fact remains that more students were unmatched this year. The numbers of students entering the Match tell the story. This year, a total of 34,355 active applicants—including nearly 1,000 more U.S. medical school seniors—competed for one of 26,392 first-year residency training positions in the Match. In 2012, an all-time high of 95.1 percent of medical school seniors matched. In 2013, that percentage dropped to 93.7, according to the National Resident Matching Program.

What are the lessons to be learned from this year’s Match results?

First, the 2013 Match makes clear the urgent need to increase federal support for residency training, also known as graduate medical education (GME). As I have written and said many times, the United States is facing a shortage of 90,000 physicians by 2020. Medical schools are doing their part to ensure America has enough doctors and are on track to reach a 30 percent enrollment increase over 2002 levels by 2017. But these expansion efforts will not result in a single additional practicing physician until Congress lifts the 1997 cap on the number of residency training positions it supports through Medicare. Inaction will mean extensive shortages of both primary care physicians and a wide range of specialists. Legislation has been introduced in the House and Senate to increase the number of Medicare-supported GME positions, and the AAMC will continue to advocate vigorously for the passage of this legislation.

Second, we need to do a better job advising students about the realities of a more competitive environment for residency training positions. Under the leadership of our chief academic officer, John Prescott, M.D., the AAMC is making it a priority to assist medical schools in advising students so they are more successful in the 2014 Match. We have sent a survey to current residents who did not enter residency programs immediately after medical school graduation to understand the reasons for their delay and to determine what they did between medical school and residency. We also are exploring their past advising experiences to identify ways advisers can best support future students as they enter residency. While the results are not yet in, the information garnered from these now-residents will be used to help medical schools improve their advising efforts.

In the meantime, student affairs deans revealed some of the strategies that this year’s unmatched students and their schools are employing. Many unmatched students will spend a year conducting research, while others will pursue an additional credential, like a master’s degree in public health, to be more competitive in next year’s Match.

Looking ahead, our conversations with deans and student advisers at our member medical schools indicate that many are developing institutional strategies to enhance their students’ ability to match in the future and are creating opportunities on campus for those who do not match. Nearly everyone with whom I speak is asking how best to advise and counsel future students as they prepare for an increasingly competitive Match. This is an issue best stemmed early, since it can have compounding effects— the 528 unmatched students from this year join the ranks of more than 700 other M.D. graduates who did not match in previous years.

As the results of this year’s Match show, the nation’s medical school graduates already are feeling the painful effects of the 16-year-old cap on the number of federally supported residency training positions. Let us take a lesson from the 2013 Match. Unless Congress acts to expand GME training, patients will be the next to feel the squeeze when they have to wait longer to see a physician! The AAMC and the nation’s medical schools are committed to ensuring that does not come to pass.