To the Editor:
In support of their argument for more residency training positions and alternative postgraduate training pathways, Drs. Dewan and Norcini note that “4,170 [applicants] in 2019 failed to get a position through the National Resident Matching Program [NRMP] Main Match.” 1 This is an accurate citation of the number of unmatched applicants from the NRMP’s report. 2 However, this figure underestimates the actual number of doctors who were unable to secure a residency position through the Match.
When calculating the Match rate or reporting the number of unmatched applicants, the NRMP considers only active applicants—applicants who submit a certified rank order list of programs. 2 Not all Match applicants are active applicants. Some withdraw from the Match (often after securing a residency position outside of the NRMP Match), while others simply do not submit a rank order list. Excluding these groups when calculating the Match rate is understandable, but the number of applicants who fail to submit a rank order list should be considered when estimating the number of doctors who are unable to become residency-trained physicians.
Although the reason why an applicant did not submit a rank order list is not included in the NRMP’s report, it is very likely that the majority of these applicants were unable to submit a rank order list due to a lack of interest in their application. An applicant who receives no interview offers has no programs to rank.
If we include applicants with no rank list alongside active applicants who went unmatched, then the number of potential physicians who were unable to secure a residency position in the 2019 Match increases to 5,772—an increase of 38%. 2 (This figure would climb further if we included previous graduates of U.S. allopathic medical schools, of which 811 went unmatched and 201 submitted no rank list in 2019.) 2 Drs. Dewan and Norcini highlight a real problem, and careful review of the NRMP statistics suggests that the scope of the problem is even greater than it may first appear.
1. Dewan MJ, Norcini JJ. We must graduate physicians, not doctors. Acad Med. 2020;95:336–339.
2. National Resident Matching Program. Results and Data: 2019 Main Residency Match. https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/04/NRMP-Results-and-Data-2019_04112019_final.pdf
. Published April 2019. Accessed October 29, 2020.