Signer, Mona M. MPH; Beran, Robert L. PhD
Ms. Signer is director, National Resident Matching Program (NRMP), Washington, D.C. Dr. Beran is executive director, NRMP, and vice president, Division of Student Affairs and Education Services, Association of American Medical Colleges, Washington, D.C.
The 2003 National Resident Matching Program (NRMP) Main Match continued upward movement in the numbers of first-year and second-year residency training positions offered, and reversed the three-year downward trend in the numbers of registered and active applicants. The match rates for most categories of applicants held steady, showing little variation from 2002.
For the first time since 1999, there was an increase in the number of applicants participating in the Match. Table 1 shows that 23,965 individuals submitted rank order lists of residency programs, 506 (2.2%) more than the 23,459 who did so in 2002. Of those 23,965 “active” applicants, 18,806 (78.5%) were matched to PGY-1 residency positions, an increase of 359 or 2.0%. The surge in applicants was accompanied by equally strong growth in the number of positions, with 23,365 first- and second-year positions offered in 2003 compared with 22,916 in 2002. Of those, 21,190 or 90.7% were filled, an increase of 520 over the 2002 Match (see Tables 2 and 3).
The single largest factor contributing to the increase in applicants was a reversal of the downward trend in the number of non–U.S. citizen graduates of foreign medical schools (IMGs). Non-citizen IMGs submitting rank order lists for the 2003 Match numbered 5,029, compared with 4,556 in the 2002 Match. The 473 additional applicants represent a 10.4% increase over 2002. The number of U.S. medical school seniors held steady at 14,332, only 4 fewer than last year.
The match rates (percentages of applicants who obtained positions) for most subgroups shown in Table 1 varied less than 1.0% from the 2002 Match. The sole exception was among non–U.S. citizen IMGs, whose match rate increased 4.4%. For the first time ever, the match rate for those applicants (55.7%) exceeded that for U.S. citizen IMGs (54.6%). Further examination of both U.S. citizen and non–U.S. citizen IMGs who registered for the match but did not actively participate shows that 1,713 were withdrawn because they lacked certification by the Educational Commission for Foreign Medical Graduates (ECFMG), 501 (30%) fewer than the number withdrawn in 2002 for the same reason.
Both the number of PGY-1 positions offered and the fill rate increased in 2003. The number of positions grew by 306 to 20,908, and the fill rate increase by 0.4% to 89.9%. The biggest increase in PGY-1 positions was 164 (10%) in Preliminary Internal Medicine, followed by 45 more in Pathology (11.3%). The largest decrease was again in Family Practice, down 42 positions in 2003 and a total of 373 positions since 1998.
The number of PGY-2 positions offered in the 2003 Match increased by 143 (6%) over 2002 to 2,457, with 56 more in Anesthesiology and 55 more in Diagnostic Radiology. Of the 2,457 PGY-2 positions offered, 2,384 or 97% were filled, 161 more than in 2002. The 2003 fill rate for PGY-2 positions continued the steady upward trend experienced by the NRMP. The PGY-2 fill rates for 1996 and 2002 were 51.1% and 96.1%, respectively.
Specialties' fill rates by types of applicants are shown in Tables 2 and 3. Notable changes from 2002 include:
▪ General Surgery PGY-1: matched 85 more U.S. seniors and increased the fill rate from 94.4% to 99.0%
▪ Preliminary Surgery: matched 46 more U.S. seniors and increased the fill rate from 58.1% to 64.4%
▪ Pediatrics: filled 107 more positions, took 33 more U.S. seniors, and increased the fill rate to 94.0%
▪ Preliminary Internal Medicine: offered more positions, filled more positions, and filled them with 70 more U.S. seniors, supporting the general trend toward specialization
▪ Family Practice: matched 115 fewer positions and 173 fewer U.S. seniors, resulting in a 2.8% decline in its fill rate
▪ Anesthesiology PGY-2: filled 59 more positions and continued to increase the number of U.S. seniors matched as well as the fill rate (95.6%), a remarkable change from the 1996 rate of 29.6%
▪ Diagnostic Radiology PGY-2: filled 841 positions, an increase of 65 over 2002, including 46 more U.S. seniors
▪ Physical Medicine and Rehabilitation PGY-2: filled 252 positions (91.6% of positions offered) and increased the number of U.S. seniors by 24
Recently, there has been interest in workforce issues related to General Surgery. In the 2003 Match, Surgery categorical programs (excluding Preliminary Surgery programs) offered 1,049 positions, 10 more than in 2002. Of those, 1,038 (99.0%) were filled, 57 more than in 2002 and an increase of 5.6%. The number of U.S. seniors matched to those positions rose by 85 (7.4%) to 867, the first increase in the past three years.
Continuing a trend that began with the 1997 Match, less that half (44.2%) or 5,909 U.S. medical school seniors matched to first-year residency positions in the generalist specialties, a decrease of 345 or 2.2% from 2002. The generalist specialties are defined as Family Practice, Internal Medicine, Internal Medicine–Pediatrics, Internal Medicine–Primary, Pediatrics, and Pediatrics–Primary. Preliminary Medicine positions are not included. Five of those six specialties matched fewer U.S. seniors in 2003 than in 2002. The exception was Pediatrics, which increased from 1,563 to 1,596.
The number of applicants who entered the Match as part of a couple was 1,150 this year, the most ever. Couples continued to experience success, with match rates above 90% since 1984 and a 2003 match rate of 93.9%, 1.2% lower than in 2003. Two partners identify themselves as a couple to the NRMP and submit rank order lists of identical length. The algorithm treats the two lists as a unit, matching the couple to the highest-linked pair of program choices where both partners match to the programs listed. The vast majority of couples are U.S. seniors, and their match rates are similar to those of their classmates, varying within one or two percentage points each year.
Data describing the trends in positions offered and filled by U.S. seniors and other applicants during the past several years are published annually in the NRMP Results and Data. It is available from the National Resident Matching Program, attn: Membership and Publications Orders, 2450 N Street NW, Washington, DC 20037-1134, or by calling Publications at (202) 828-0416.