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A Word From the President: Ensuring Residency Opportunities, Today and Into the Future

AAMC Reporter: April 2014

One of the happiest days in the lives of most graduating medical students is Match Day. During ceremonies around the nation, when students learn where they will be spending the next few years training in residency programs, that moment of anticipation is palpable as soon-to-be graduates wait to open the envelopes that move them closer to their dreams of practicing medicine. Family, friends—even people the students have never met—join the celebration while standing on the sidelines, reading tweets, or watching streaming videos. For me, witnessing the students’ sheer excitement as they reach this milestone is reason enough to cheer.

I am pleased that the overall results of the Match were successful this year. Based on our preliminary analysis of the data and the feedback from many medical schools, we saw strong competition for residency positions. Overall, we saw a 94.4 percent match rate among U.S. seniors. The National Resident Matching Program® (NRMP®) reported this year’s Match included more than 34,270 active applicants—a record number—vying for 29,671 positions. The NRMP also reported a modest increase in U.S. seniors choosing primary care programs. And more than 80 percent of U.S. seniors and 81 percent of independent applicants matched to one of their top three specialty choices.

My happiness for these soon-to-be residents, however, is tempered by the fact that several hundred U.S. medical students did not match to a first-year residency training program. This number of unmatched students should give all of us pause. Consider the costs. First and foremost, there is a true cost to our profession and the public, which will miss the talents these students would otherwise bring to medicine. And for the unmatched students themselves, they will be graduating from medical school with potential six-figure debts and an unclear pathway into the profession they have chosen.

Second, consider the cost of what such a mismatch means in a country already facing an impending doctor shortage. Our nation’s population is a growing and graying one. In addition to a great need for health care created by an aging population, the number of people with health insurance is now increasing. Compounding this problem, some of the 10,000 baby boomers turning 65 every day are physicians who are considering retirement themselves. We expect one third of the nation’s doctors to retire in the next decade. If we do not replace them, America’s patients may find that having access to insurance will not guarantee having access to a doctor. That stark reality reminds us that we should do everything in our power to educate and train the physicians we will need in the future.

Also consider that U.S medical school enrollment is projected to increase to 21,349 students by 2018, according to the most recent AAMC Survey of Medical School Enrollment Plans, a report from our association’s Center for Workforce Studies. Combine that increase with a greater number of graduates coming from osteopathic schools and a growing number of international graduates entering the Match, and we could soon face a major mismatch where the number of newly graduated doctors may exceed the number of available residency positions. That serves no one well.

Understanding the severity of the crisis, the nation’s medical schools and teaching hospitals acted to address these shortages. Our member institutions boosted medical enrollments, opened more medical schools, and voluntarily created new residency training positions, at a cost of $1 billion per year over the last decade. What our member institutions can do alone without help from the nation’s policymakers to address the doctor shortage, however, is limited.

Things like keeping the 17-year cap on federal support for new doctor training could impede the progress of medical students in the next step of their careers—and limit the number of doctors our nation will have. Given the increased need for more doctors—both primary care and other medical specialties—why would we want to limit the number of doctors we can train for the people who need them?

It does not have to be this way. We need our federal partners to do their part to ensure an adequate supply of physicians. Congress can begin to do just that by passing legislation that would enable us to train an additional 4,000 doctors a year—a modest increase—and would supplement the good work medical schools and teaching hospitals already are embracing to improve efficiency through interdisciplinary teams and new models in care delivery.

We must act soon. We cannot ignore the looming physician shortage any more than we can wish for a magic wand to wave it away. We must make sure that the students heeding the call to meet the growing medical needs of our nation will have the chance to tweet “#iMatched,” sharing their pride with the world. We need to make sure that we are giving medical students the chance to become the doctors they always wanted to be—and the doctors our nation so desperately needs them to be.