To the Editor: The number of graduating US medical students is increasing more rapidly than the number of postgraduate training positions.1 The National Resident Matching Program (NRMP) has experienced a decrease in the number of unfilled positions for first postgraduate year (PGY-1) training while the number of unmatched seniors in US allopathic medical schools (US MDs) has remained stable.2 After the 2010 NRMP, there were for the first time more unmatched US MD seniors (1078) than available PGY-1 positions (1060).2 Applicants who fail to match either through the NRMP or the programs occurring earlier each winter (the Department of Defense Match and the San Francisco Match) scramble for the remaining PGY-1 positions after the NRMP match. Because this process is unmonitored, it has been unclear how many qualified US MD students fail to acquire a PGY-1 position through the matching programs and the subsequent scramble. This study was undertaken to determine this number for 2010 US MD graduates.
Two weeks after the 2010 NRMP match (which occurred on March 15, 2010), an email survey was conducted among student affairs deans of the 126 US MD medical schools with a 2010 graduating class. Each dean was asked to report the number of seniors participating in the NRMP; number of seniors unmatched after the NRMP; number of seniors without a PGY-1 position 2 weeks after the NRMP; number of fully qualified seniors without a PGY-1 position for July 1, 2010; the dean's opinion of the primary reasons each senior failed to acquire a PGY-1 position; and number of graduates from previous classes participating in and matching during the 2010 NRMP. Ten possible reasons for failing to match were listed, with an open line for “other” also provided (Table). The survey closed on April 20, 2010. Of the 126 deans, 111 (88%) responded; there were no geographic or public/private differences among the nonrespondents. The study was determined to be an exempt form of human subjects research by the Association of American Medical Colleges institutional review board.
The deans reported that 871 of 14 623 participating seniors (6.0%; range, 0-26 students per school) were unmatched after the NRMP (Table). This is similar to the 6.7% for US seniors failing to match reported by the NRMP.2 Of these 871 seniors, 194 remained without a PGY-1 position after the scramble, but only 179 (1.2% of 14 623; range, 0-12 students per school) were believed by their deans to be fully qualified to start PGY-1 training; 15 were judged not qualified. The leading reasons reported for qualified students' failure to obtain a PGY-1 position were “not competitive for first choice specialty” and “USMLE score issues.”
US MD seniors filled 65.7% of available PGY-1 positions in the 2010 NRMP match, but 95.4% of the positions were filled, the difference consisting primarily of graduates of osteopathic medical schools, US citizen graduates of international medical schools, and non–US citizen graduates of international medical schools.2 The percentage of US MD seniors failing to match through the NRMP has remained stable at 6% to 7% during the past 5 years.2 However, the number of unfilled PGY-1 positions after the match has decreased from 1587 in 2006 to 1060 in 2010.2
Study limitations include an inability to confirm the accuracy of the deans' reports and opinions. Nevertheless, this survey indicates that a significant number of seniors may fail to realistically assess their competitiveness for postgraduate positions in the most highly sought fields or fail to rank programs in less competitive specialties. With the number of positions after the NRMP match decreasing, efforts must be made to appropriately counsel senior medical students on their training options.
Author Contributions: Dr Sondheimer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosure: Dr Sondheimer reported receiving compensation as a full-time employee of the Association of American Medical Colleges.
Additional Contributions: Lauren Jolliff, BA, provided technical assistance; she received compensation as a full-time employee of the Association of American Medical Colleges.
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