To the Editor:
We thank Drs. Gruppuso and Adashi1 for drawing attention to the relentless inflation in the number of residency applications being submitted each year. Despite the associated costs, students feel compelled to submit a high volume of applications to remain competitive. We believe that transparency both at the level of the Match and of individual programs is necessary to inform sensible and successful application strategies.
Responding to students’ anxiety, the authors called for more data, such as “the number of GME [graduate medical education] program interviews offered and/or accepted per applicant” and “whether or not the number of GME program interviews per applicant is predictive of a successful match.”1 But these system-level data are already available. Applicant surveys and outcomes reports from the National Resident Matching Program (NRMP) consistently show that applicants who interview at and rank more programs are more likely to match successfully.2–4
Therefore, the real question for the individual applicant is how to obtain a reasonable number of interview offers. Volume is an increasingly common tactic. Between 2009 and 2015, among matched U.S. allopathic seniors, the median number of applications submitted per applicant increased 36%.2,3 However, a recent study found no relationship between yearly match rates in each specialty and the average numbers of applications submitted per student.5 We have reached the point of diminishing returns.
A reasonable solution is specialty-specific application caps, in combination with program-level transparency regarding selection processes and outcomes.6 For instance, the NRMP provides programs with statistical profiles of their matched applicants. Releasing such historical data would allow students to gauge their competitiveness for a particular program and effectively focus their application strategies. It is time for the GME community to halt the application arms race.
Francis Deng, MD
Resident in diagnostic radiology, Massachusetts General Hospital, and clinical fellow, Harvard Medical School, Boston, Massachusetts; [email protected]; ORCID: http://orcid.org/0000-0003-3117-5076.
Jenny X. Chen, MD
Resident in otolaryngology, Massachusetts Eye and Ear, and clinical fellow, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-2992-4771.
Austin Wesevich, MD, MPH
Resident in internal medicine and pediatrics, Duke University Medical Center, Durham, North Carolina; ORCID: http://orcid.org/0000-0001-5202-1231.
1. Gruppuso PA, Adashi EY. Residency placement fever: Is it time for a reevaluation? [published online ahead of print November 1, 2016]. Acad Med. doi: 10.1097/ACM.0000000000001468.
2. National Resident Matching Program. Results of the 2015 NRMP Applicant Survey by preferred specialty and applicant type. www.nrmp.org/wp-content/uploads/2015/09/Applicant-Survey-Report-2015.pdf
. Accessed November 7, 2016.
3. National Resident Matching Program. Results of the 2009 NRMP Applicant Survey by preferred specialty and applicant type. http://www.nrmp.org/wp-content/uploads/2013/08/applicantresultsbyspecialty2009.pdf
. Accessed November 8, 2016.
4. National Resident Matching Program. Charting outcomes in the Match for U.S. allopathic seniors, 2016. http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf
. Accessed November 9, 2016.
5. Weissbart SJ, Kim SJ, Feinn RS, Stock JA. Relationship between the number of residency applications and the yearly match rate: Time to start thinking about an application limit? J Grad Med Educ. 2015;7:8185.
6. Pereira AG, Chelminski PR, Chheda SG, et al.; Medical Student to Resident Interface Committee Workgroup on the Interview Season. Application inflation for internal medicine applicants in the Match: Drivers, consequences, and potential solutions. Am J Med. 2016;129:885891.