ARTICLE IN BRIEF
Neurology residency program directors comment on the latest data from the National Residency Match Program.
Nearly fifty-percent of US medical school seniors matched to post-graduate year 1 (PGY 1) neurology residencies this year — a decline from 62.8 percent in 2009 — even though an additional 32 slots (228 total positions) were offered. PGY 1 residencies include the internship year with the neurology residency during the subsequent three years.
But whether this and other statistics from the 2010 National Resident Matching Program signals a trend or is a mere blip is fodder for discussion among residency program directors.
“I think it's really just some noise,” said Steven Galetta, MD, director of the Division of Neuro-Ophthalmology and residency program director for the department of neurology at the University of Pennsylvania. “Overall, there's been fairly nice growth in the number and quality of applicants over the last several years.”
Although almost half of the US medical school seniors who applied to PGY 1 residencies didn't match, the total number of US medical school seniors who applied to both PGY I and PGY 2 residencies increased to 649 in 2010 (compared to 638 in 2009), and the total number of matches reduced by only one.
Considering the overall numbers, what factors contributed to the decrease in the percentage of US medical school seniors applying and matching to PGY 1 neurology residencies?
“Some residents don't want to do their residency where they do their internship,” said Joel Morgenlander, MD, professor of neurology at Duke University School of Medicine and second vice president of the Association of University Professors of Neurology (AUPN). It's more the applicant's choice of which type of program they prefer. “Also, family considerations tend to have folks do their internship at medical school or in some other area from where they do their residency.”
Indeed, personal circumstances may contribute to the decreased percentage of US medical school seniors applying for PGY 1 residencies. As medical school class sizes and the number of women in medical school increase there is more emphasis placed on the significant other and family. “It's not uncommon for students to be matching with a student in their class, who is often in a different specialty,” which may limit the number of residency programs they apply to, said Dr. Galetta.
Said Argye Hillis, MD, executive chair of the Department of Neurology Residency Program at Johns Hopkins University School of Medicine: “They're more balanced than the applicants we've seen in the past who've made decisions for purely academic reasons. That may contribute to the decrease in applicants but we need to respect this fact.”
As a result, some residency program directors are re-evaluating and restructuring their residency programs.
“I just made a change to our program when the Match results came out,” said Dr. Galetta. “Next year we will offer four spots that include the PGY 1 and five spots that are a straight neurology residency. We want to give some of the applicants flexibility of where they do their residency [but we think it is important to offer more categorical spots in the future. We think there is going to be an increasing demand for internship spots going forward].”
In addition, the residency program at Rush University offers eight Joint Advanced/Preliminary positions through an arrangement with department of internal medicine. Those applicants who match to PGY 2 positions have the option to complete their PGY 1 year at Rush University in the internal medicine department, but are not required to, said Steven L. Lewis, MD, professor and associate chairman of the Department of Neurological Sciences and neurology residency director at Rush University. “We feel that our ability to offer this option to our applicants has been beneficial to us and our applicants knowing that some applicants may still wish to consider doing a preliminary medicine year elsewhere, including at their home institution.”
“Neurology is clearly better off in the last 10 years than it was in the 1990s, it terms of its perception as a field for medical students to go into,” said Dr. Lewis. “It's been much less challenging to recruit students in the last 10 years.”
All of the residency program directors that Neurology Today spoke with agreed that this year's Match produced an overabundance of qualified applicants — many more than they could accept at their institutions. Yet, they remain mindful that they must engage in continual recruitment efforts in order to attract highly-qualified medical school students to neurology.
One way is to take students out of the classroom and to have them see real patients to gain some hands-on experience, said Dr. Hillis. Patients with neurologic disease are interested and passionate about their own diseases, and they're passionate about trying to get young scientists interested in finding new treatments to make them better.
This will also put students in contact with what Dr. Hillis called “star clinicians” who have a real passion for taking care of patients with neurologic disease, which will help students understand the excitement associated with helping these patients.
“Our plan is to do a very effective job in getting them interested during medical school,” said Dr. Galetta. “We have a highly organized neurology clinical courtship that helps recruit them. Medical students need role models and mentors that they can look up and relate. Often times they will choose the specialty that provides for them.”
Residency program directors will also receive help and guidance on how to effectively recruit medical school students. The AAN has an active consortium of neurology program directors that shares information about recruitment strategies and it even runs a boot camp, according to Dr. Morgenlander. “Since there is a reasonable amount of turnover in residency directors the AAN created a concentrated education program in which folks who have experience running programs share information in a much more active way,” he said.
“We're really working together and are trying to help others run their programs better,” said Dr. Morgenlander. “I think in general we want to train good neurologists — it's not one institution out solely for its own benefit. We want to train them the right way: That's our group mission.” •
For more on training issues and concerns specific to neurology residents, visit the Residency and Fellow Section page of Neurology online: www.neurology.org/misc/Residents_and_Fellows.dtl