Match Day Results Show Need to Increase Graduate Medical Education Slots
AAMC Reporter April 2013
—By Rebecca Greenberg
Last month, in Match Day ceremonies across the county, fourth-year medical students anxiously waited to open envelopes that would reveal where they would spend the next three to seven years of their residency training. This day marked a rite of passage for matched seniors, who had just spent four hard years building their academic records and charting their career paths.
As most students celebrated this important milestone, others faced disappointment. This year, 1,097 U.S. senior medical students did not match in the first round—up from 815 last year—even though Match participation was at an all-time high of more than 40,000, according to the National Resident Matching Program® (NRMP®).
“Match Day is usually a day of excitement, enthusiasm, and joy for medical students around the country,” AAMC President and CEO Darrell G. Kirch, M.D., said in a statement. “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.”
On the Friday before Match Day, students learned if, but not where, they matched. Students who did not match entered the NRMP’s Supplemental Offer and Acceptance Program (SOAP), where they submitted applications through the AAMC’s Electronic Residency Application Service (ERAS®) and had the opportunity to accept offers from programs with unfilled slots. By the end of Match Week, 528 U.S. M.D. graduates did not have a residency position.
This year’s Match was a “little busier” than previous years because of higher numbers of unmatched students who hurried to reapply through SOAP, explained Lauree Thomas, M.D., associate dean at the University of Texas Medical Branch. Students identified at risk of not matching were advised to interview at as many programs as possible and to rank all of them, but not all followed this advice. Some, according to Thomas, came away empty-handed.
Laurie Glimcher, M.D., dean of Weill Cornell Medical College, emphasized the importance of students consulting with faculty. “Students who haven’t matched in the past primarily did so because they didn’t take advice about listing and ranking schools in a reasonable order,” she said. Glimcher noted that all students at Weill Cornell found a position, many of them receiving their top choices. “I think this year was a testament to the fact that students really did listen,” she said.
This year’s Match was the first for Florida International University Herbert Wertheim College of Medicine (FIU), which admitted its charter class in 2009. Associate Dean Robert Hernandez, M.D., said the process was both “exciting and nerve-racking” because of concerns that students might be at a disadvantage coming from a school with no match record.
FIU deans began preparing students more than a year in advance. “We go through their CVs to see if there are additional activities they should participate in. We look at their academic records and see if there are things they need to improve,” Hernandez said. “Always, we want our students to do things that they are interested in, not just because it’s going to make them a better candidate. Nonetheless, we’ve got to be realistic and try to encourage them to think about what programs are looking for in a competitive applicant.” In the end, all of FIU’s students found positions.
With limited slots available, especially in competitive specialties such as dermatology, student affairs deans will continue to adapt strategies to ensure future seniors are strong contenders. But even with these measures in place, some students still will not match. Many consider this daunting at a time when the nation faces a physician shortage.
“We don’t want any senior medical students having alternate career plans,” Thomas said. “We want to keep those students in the pipeline for future training, particularly in primary care, given the tremendous need.” In response to the estimated shortage of 90,000 physicians by 2020, medical schools such as the University of Texas Medical Branch have increased enrollment, and new medical schools such as FIU have opened their doors. The number of federally supported residency positions, however, is not increasing at a pace to accommodate the number of graduates.
Richard Wheeler, M.D., executive associate dean for academic affairs at the University of Arkansas for Medical Sciences College of Medicine (UAMS), reported that several UAMS students who completed M.D. requirements were unable to obtain residency positions, making them ineligible to practice medicine. “It is very disappointing that we, along with many other medical schools in this country, have tried to respond to the call for increased class sizes to address the looming shortage of physicians only to have our students suffer from the lack of a concomitant increase in the number of residency positions,” he said.
The AAMC is advocating to increase the number of Medicare-supported graduate medical education positions, supporting legislation such as the “Training Tomorrow’s Doctors Today Act” and the “Resident Physician Shortage Reduction Act of 2013.” Provisions in these bills will allow medical schools and teaching hospitals to train an additional 3,000 to 4,000 physicians per year. Such efforts aim to ensure fewer medical students will be unmatched.
“The lawmakers who have introduced these measures understand how urgent the doctor shortage has become,” said Atul Grover, M.D., Ph.D., AAMC chief public policy officer. “If policymakers don’t act soon, sequestration and proposed funding cuts will severely impact teaching hospitals’ ability to train the next generation of physicians and make the squeeze even tighter for future graduates. By the time patients notice the doctor shortage, it will be too late. America needs more doctors now.”
- Match Results Raise Concerns—STAT, March 18, 2013
- AAMC Concerned About Reports of Unmatched Students—news release, March 15, 2013
- Match Day 2013—Second Opinion, March 15, 2013
“We don’t want any senior medical students having alternate career plans. . . We want to keep those students in the pipeline for future training, particularly in primary care, given the tremendous need.”
—Lauree Thomas, M.D.