Main Match Trends 2015

[IMPD]

Interesting read from the NRMP. As a PD who participated in the somewhat chaotic listserv this spring, I have to give it up for Mona Signer who handled nearly epic levels of PD and TPA freakout fairly well.

Her presentation shows, as expected, no PGY1 position "cliff" and no imminent time when AMG numbers will get anywhere close to exceeding PGY1 positions.

What is happening (in my opinion) is that the caste system of desirable and undesirable spots continues to create a state of anxiety/panic among some medical students. I mean, if available spots exceed MSIV grads by >9,200, what we're really talking about when >600 AMGs remain unmatched at the end of SOAP is that many many of those spots are not desirable and kids would rather do a "5th year", "research" or nothing rather than match at those programs.

This is supported by the %s of kids who don't match. They were (mainly) applicants who entered only Derm, NeuroSurg, ENT, Ortho and ThoracicSurg on their rank lists. My prediction is that almost no one learns from this to use backups who wasn't already going to. So it goes.

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[Raryn]

Interesting read from the NRMP. As a PD who participated in the somewhat chaotic listserv this spring, I have to give it up for Mona Signer who handled nearly epic levels of PD and TPA freakout fairly well.

Her presentation shows, as expected, no PGY1 position "cliff" and no imminent time when AMG numbers will get anywhere close to exceeding PGY1 positions.

What is happening (in my opinion) is that the caste system of desirable and undesirable spots continues to create a state of anxiety/panic among some medical students. I mean, if available spots exceed MSIV grads by >9,200, what we're really talking about when >600 AMGs remain unmatched at the end of SOAP is that many many of those spots are not desirable and kids would rather do a "5th year", "research" or nothing rather than match at those programs.

This is supported by the %s of kids who don't match. They were (mainly) applicants who entered only Derm, NeuroSurg, ENT, Ortho and ThoracicSurg on their rank lists. My prediction is that almost no one learns from this to use backups who wasn't already going to. So it goes.

Link?

 

[Chicago2012]

Here you go

 

[j4pac]

Was there any mention of the influx of DOs and IMG/FMGs applying and taking AMG seats?

Was there also any mention of the Allo-osteo merger and the effect on PGY seats?

 

[IMPD]

http://www.nrmp.org/wp-content/uploads/2015/05/Mona-GSA-presentation-2015-Final.pdf

 

[IMPD]

Was there any mention of the influx of DOs and IMG/FMGs applying and taking AMG seats?

Was there also any mention of the Allo-osteo merger and the effect on PGY seats?

Page 34 addresses some parts of those questions. There were 2300 DOs matched and 6300 IMGs matched this year. There are >9000 more spots in the Match than AMGs. There is no way that DOs and IMGs are "taking positions" from AMGs in the mathematical sense of the phrase. As I said originally, there are many positions that AMGs are not applying to since it seems likely that the 600 AMGs who went unmatched even after SOAP could have found a position amongst those 9000 if they had wanted it.

 

[j4pac]

Page 34 addresses some parts of those questions. There were 2300 DOs matched and 6300 IMGs matched this year. There are >9000 more spots in the Match than AMGs. There is no way that DOs and IMGs are "taking positions" from AMGs in the mathematical sense of the phrase. As I said originally, there are many positions that AMGs are not applying to since it seems likely that the 600 AMGs who went unmatched even after SOAP could have found a position amongst those 9000 if they had wanted it.

I'm curious what you mean by that? Is the applicant suppose to know that they won't match...and are they also suppose to know that they should have applied to a bunch of IM and FP programs along with their specialty of choice?

Applying to residency is EXPENSIVE and TIME CONSUMING. I know personally that I spent about $7k on the process and went on 10 interviews. It got to the point that I had to cancel interviews because of other obligations. There are AMGs who I am sure did not match after going on a similar number of interviews and spending a similar amount of money this cycle. It is easy to say that they should have applied more broadly...but is that even practical considering the amount of money and time that the applicant is already investing to the process.

 

[gutonc]

I'm curious what you mean by that? Is the applicant suppose to know that they won't match...and are they also suppose to know that they should have applied to a bunch of IM and FP programs along with their specialty of choice?

I think it's pretty common that people who don't match have a pretty good inkling that that might be the case for them. Not all of course, but many. The people who are completely blind-sided by it are typically the ones with minimal personal insight.

Applying to residency is EXPENSIVE and TIME CONSUMING. I know personally that I spent about $7k on the process and went on 10 interviews. It got to the point that I had to cancel interviews because of other obligations. There are AMGs who I am sure did not match after going on a similar number of interviews and spending a similar amount of money this cycle. It is easy to say that they should have applied more broadly...but is that even practical considering the amount of money and time that the applicant is already investing to the process.

$7K is a drop in the bucket compared to a $250K debt load. I'm not going to argue that the interview process is cheap, but applying doesn't cost all that much. You can apply to 100 programs for about $2K. Certainly not cheap, but that's nothing compared to the lost opportunity cost of not matching.

 

[j4pac]

I think it's pretty common that people who don't match have a pretty good inkling that that might be the case for them. Not all of course, but many. The people who are completely blind-sided by it are typically the ones with minimal personal insight.


$7K is a drop in the bucket compared to a $250K debt load. I'm not going to argue that the interview process is cheap, but applying doesn't cost all that much. You can apply to 100 programs for about $2K. Certainly not cheap, but that's nothing compared to the lost opportunity cost of not matching.

You aren't talking about 100 programs...you are really talking about thousands of programs. Even if you won the lotto and can afford to apply to all of those programs...you don't have the time to travel to all of those programs. When does it end? The time investment is very real. I've known multiple people who applied to MULTIPLE PM&R programs and transitional programs. By the time it was all said and done...they visited about 20 sites. Would you recommend that they would attend EVEN MORE? And if so...how do they even know where to go? Again...there are thousands of programs out there.

I think that PDs are making it seem far more simplistic than it really is. And I am saying this as a guy who matched and a guy who has a very strong understanding of the charting outcomes. Yes...the majority of the AMGs who failed to match did so because they didn't apply broadly enough, or realistically. But there are also those out there who were the victim of a ridiculous numbers game...I know some of these people. And it is even more true for DOs...and significantly more true for IMG/FMGs.

 

[Chicago2012]

I would like to know what these programs are that I should be applying to. I applied broadly in FM and mostly stayed away from big city programs and programs that were obviously out of my reach. Interviewed at 8 programs and was told multiple times that I handled myself extremely well during interviews. Still unmatched.

 

[IMPD]

I would like to know what these programs are that I should be applying to. I applied broadly in FM and mostly stayed away from big city programs and programs that were obviously out of my reach. Interviewed at 8 programs and was told multiple times that I handled myself extremely well during interviews. Still unmatched.

I would guess that you are not in the group of AMGs that I was referring to. The folks I am talking about are the Derm, Thoracic Surg, ENT, Ortho and Plastics applicants.

 

[j4pac]

If you go back to @IMPD 's original post...kind of the whole point is that this group of candidates (competitive US seniors) are basically making an implicit (in some cases explicit) choice that going unmatched is preferable to ending up in the caste of "undesirable" residencies.

We see year after year too further proof of this - the same cohort of candidates will actually often choose to take an extra year of research and reapply next year rather than take one of the scraps in the SOAP.

And usually it actually works out the second time around for them.

Basically the main match data confirms that for a US MD senior, going unmatched is not actually the end of the world. It profoundly sucks, but these grads end up on their feet.

This may seem like an obvious finding, but it actually has significant implications for residency funding and expansion. If your pool of US seniors is already unwilling to even consider a certain caste of residencies, what will be the end result of expanding said undesired caste?



It is definitely expensive and time consuming. It is also the most important thing you have in your life that year. So yes, some introspection regarding your chances, savings/borrowing/checking the couch cushions to maximize how much you can spend on the process, etc, is important.

No one said it was easy. But it is critically important, especially for the marginal candidate or for someone going for a competitive field.

Thanks for clearing up the first part...I missed the "choice" part of going unmatched.

 

[DokterMom]

OK - So suppose one is a competitive US senior wanting to apply to a highly competitive specialty. Said student's Step 1 is in line with matched averages for that specialty, but there are no guarantees. The most competitive specialties seem to require 12 - 16 interviews to maximize chances of matching -- so a serious investment of time and money.

From reading above, it seems like it's considered unwise for even competitive students to not have a backup specialty. So add 10-15 more interviews to maximize chances in a moderately competitive backup.

For the sake of discussion, let's use Derm as the preferred specialty and General Surgery as the backup.

Is going to 20-30 interviews even realistic? And if you have a geographic preference, how do you finesse interest in the same hospital for both specialties? I'd have to think the GS folks would not be happy to learn that you also applied to their Derm program. Or do you have to pick here for Derm, there for GS?

 

[DokterMom]

That makes sense -- But then, you wouldn't know you'd received 12-16 derm interviews until well into the process, right? At which point, it would be pretty late to apply intelligently to surgery.

So yeah - your second scenario. In that case, you'd have your 5-6 derm interviews and 10-15 GS interviews? Guess that's do-able.

 

[calvnandhobbs68]

If you go back to @IMPD 's original post...kind of the whole point is that this group of candidates (competitive US seniors) are basically making an implicit (in some cases explicit) choice that going unmatched is preferable to ending up in the caste of "undesirable" residencies.

We see year after year too further proof of this - the same cohort of candidates will actually often choose to take an extra year of research and reapply next year rather than take one of the scraps in the SOAP.

And usually it actually works out the second time around for them.

Basically the main match data confirms that for a US MD senior, going unmatched is not actually the end of the world. It profoundly sucks, but these grads end up on their feet.

This may seem like an obvious finding, but it actually has significant implications for residency funding and expansion. If your pool of US seniors is already unwilling to even consider a certain caste of residencies, what will be the end result of expanding said undesired caste?

It is definitely expensive and time consuming. It is also the most important thing you have in your life that year. So yes, some introspection regarding your chances, savings/borrowing/checking the couch cushions to maximize how much you can spend on the process, etc, is important.

No one said it was easy. But it is critically important, especially for the marginal candidate or for someone going for a competitive field.

I think it's interesting that you say it usually works out for the people who graduate, do a "research year" and reapply. I guess we don't have great statistics overall on how this works out (since they get lumped into the "independent applicants" in the NRMP stats) but there have been hugely varying opinions on here on how well that works out. Can't say I've personally known anyone in that situation but the prevailing belief seems to be that when you're out of that allopathic senior pool, your chances drop significantly.

 

[Campanella]

I think it's interesting that you say it usually works out for the people who graduate, do a "research year" and reapply. I guess we don't have great statistics overall on how this works out (since they get lumped into the "independent applicants" in the NRMP stats) but there have been hugely varying opinions on here on how well that works out. Can't say I've personally known anyone in that situation but the prevailing belief seems to be that when you're out of that allopathic senior pool, your chances drop significantly.

The closest data available for that is on page 24 of the linked powerpoint, which shows previous US grads having a roughly 45% chance of matching during the 2015 cycle. However, this group includes people who are switching residencies or trying to get a categorical position after previously SOAPing into a preliminary position, so there is no isolated data for applicants taking a research year. Either way, a US grad's odds of matching definitely decrease after graduation.

 

[SLC]

I think it's pretty common that people who don't match have a pretty good inkling that that might be the case for them. Not all of course, but many. The people who are completely blind-sided by it are typically the ones with minimal personal insight.

I wonder which one of these best applies to me? I had a twinge of suspicion a few days before match results came out, but pushed it back down because my app was supposedly extremely strong for the field, and all my advisors said not to worry. Poor personal insight? I hope not, but the main symptom would be not knowing that I had poor insight in the first place so who knows?

Even now, at graduation my advisors were all flabbergasted at what happened. And I still don't know exactly (or even a little bit) why.

I made out extremely well in SOAP BTW. There was a program that had a position that was much much stronger than any I had applied for and I got that position. So I'm happy with the outcome, but I honestly don't know why I didn't match, and just have that one "feeling" I got the weekend before that Monday.

 

[DoctwoB]

If you go back to @IMPD 's original post...kind of the whole point is that this group of candidates (competitive US seniors) are basically making an implicit (in some cases explicit) choice that going unmatched is preferable to ending up in the caste of "undesirable" residencies.

We see year after year too further proof of this - the same cohort of candidates will actually often choose to take an extra year of research and reapply next year rather than take one of the scraps in the SOAP.

And usually it actually works out the second time around for them.

Basically the main match data confirms that for a US MD senior, going unmatched is not actually the end of the world. It profoundly sucks, but these grads end up on their feet.

This may seem like an obvious finding, but it actually has significant implications for residency funding and expansion. If your pool of US seniors is already unwilling to even consider a certain caste of residencies, what will be the end result of expanding said undesired caste?

That's one thing I never understood about arguing for expansion of residency spots. Most academic programs (especially the big names) have been adding spots without funding for a while now and have as many residents as they (or the RRC) feel they can support while maintaining educational standards. New spots opening aren't going to be for derm at Mass Gen, they will be for Fm/IM in Podunk, USA. All this would do is increase the number of IMGs who match in the US. While this may be a goal for those who think we have a physician shortage, it will hardly be a boon to US grads (and may make things worse when looking for jobs by saturating the market).

 

[Law2Doc]

I think it's interesting that you say it usually works out for the people who graduate, do a "research year" and reapply. I guess we don't have great statistics overall on how this works out (since they get lumped into the "independent applicants" in the NRMP stats) but there have been hugely varying opinions on here on how well that works out. Can't say I've personally known anyone in that situation but the prevailing belief seems to be that when you're out of that allopathic senior pool, your chances drop significantly.

FWIW if you are looking for anecdotal evidence I know two people who did the research year thing after coming up short for competitive spots and both matched into exactly what they wanted the following year.

 

[IMPD]

That's one thing I never understood about arguing for expansion of residency spots. Most academic programs (especially the big names) have been adding spots without funding for a while now and have as many residents as they (or the RRC) feel they can support while maintaining educational standards. New spots opening aren't going to be for derm at Mass Gen, they will be for Fm/IM in Podunk, USA. All this would do is increase the number of IMGs who match in the US. While this may be a goal for those who think we have a physician shortage, it will hardly be a boon to US grads (and may make things worse when looking for jobs by saturating the market).

Although you are correct that *if* Congress were to pass legislation increasing the cap they would write language about "primary care" into the law, it seems likely that once money comes into the system, it might end up adding spots in Derm at Mass General. Don't underestimate the ability of the haves to always get more.

I strongly feel that there are plenty of residency spots in the country. The distribution is extremely skewed, advisement is patchy and there are medical school students who need another pathway if they come up empty-handed after multiple match attempts. Residency spots are at the bottom of my "how to improve GME" list.

 

[space3223]

I wonder which one of these best applies to me? I had a twinge of suspicion a few days before match results came out, but pushed it back down because my app was supposedly extremely strong for the field, and all my advisors said not to worry. Poor personal insight? I hope not, but the main symptom would be not knowing that I had poor insight in the first place so who knows?

Even now, at graduation my advisors were all flabbergasted at what happened. And I still don't know exactly (or even a little bit) why.

I made out extremely well in SOAP BTW. There was a program that had a position that was much much stronger than any I had applied for and I got that position. So I'm happy with the outcome, but I honestly don't know why I didn't match, and just have that one "feeling" I got the weekend before that Monday.

*********************
Just a few thoughts from an MS4 trying to figure this whole thing out...
My deans this year told me that SOAP was SUPER crazy. I'm at a "Top 20 US NEWS and World Reports" type school on the East Coast. My dean told me that the #1 ranked student (AOA) failed to match into OBGYN this year and there were no positions available through SOAP for OBGYN this year so this person did not match at all this year.

Personally, I would not be surprised at all if the average number of applications increased significantly across the board. I know a few AMGs who scrambled and from what I can tell, SOAP is not any improvement for FMGs (if I remember correctly the intention was that it would be more equitable than Scramble) but it is DEFINITELY WAY WORSE for AMGs. I suspect that now 3 or so years into SOAP, AMG MS4s who are 50% -ile and below are hearing horror stories and applying to more places (this is me so I admit to some bias in this theory...) and possibly the higher ranked students are ranking fewer places (probably getting advising that was accurate pre-SOAP but not accurate now) than their lower ranked peers. I could definitely see how if someone who was a top student only ranked 8 or so programs but half of the applicants are ranking 15-20, that could explain some of the craziness this year with people with strong applications not matching. I have NO proof whatsoever that this is true, but I can't think of anything else that makes sense...

 

[NotAProgDirector]

*********************
Just a few thoughts from an MS4 trying to figure this whole thing out...
My deans this year told me that SOAP was SUPER crazy.

Based on what? The number of spots available in SOAP was basically the same. The number of unmatched applicants was the same. The spots filled in basically the same pattern as last year. There really was no difference.

I'm at a "Top 20 US NEWS and World Reports" type school on the East Coast. My dean told me that the #1 ranked student (AOA) failed to match into OBGYN this year and there were no positions available through SOAP for OBGYN this year so this person did not match at all this year.

If there are no spots available, then no matter what the system is, that person is not getting a spot.

If someone was the #1 student coming out of a top medical school and didn't get a spot, there's a reason for that. This isn't "bad luck". There's no benefit from my end to not rank someone because I think they are not coming to me -- my strategy is the same as yours, rank people in the order I want them. If a super-top student doesn't match, it's usually because they 1) only applied to a single program because they figured they were guaranteed a spot, or 2) have a big enough personality problem that shines through on the interview day.

And the number of unmatched AMG's is exactly the same year over year. If it's true that the top student in your school didn't match, that's an outlier / anomaly.

Personally, I would not be surprised at all if the average number of applications increased significantly across the board.

They have been rising, slowly, for years.

I know a few AMGs who scrambled and from what I can tell, SOAP is not any improvement for FMGs (if I remember correctly the intention was that it would be more equitable than Scramble) but it is DEFINITELY WAY WORSE for AMGs.

This really depends on what you mean by improvement/worse. Remember that in the scramble, there were ~1200 open spots and they were filled via first-come-first-served it-helps-to-be-connected way. Now, they are filled via a more meritocracy system. The vast majority of people don't get spots in SOAP because there are 15-20 people for each spot. The scramble wasn't great for AMG's.

I suspect that now 3 or so years into SOAP, AMG MS4s who are 50% -ile and below are hearing horror stories and applying to more places (this is me so I admit to some bias in this theory...)

Applications have been up every year for at least a decade for most fields

and possibly the higher ranked students are ranking fewer places (probably getting advising that was accurate pre-SOAP but not accurate now) than their lower ranked peers. I could definitely see how if someone who was a top student only ranked 8 or so programs but half of the applicants are ranking 15-20, that could explain some of the craziness this year with people with strong applications not matching. I have NO proof whatsoever that this is true, but I can't think of anything else that makes sense...

That's not the way the match works, exactly. Top candidates will match at a very high rate if they rank 8 programs. I matched many years ago, and even in my year there were stories of good people ranking a "normal" number of programs and not matching. We were encouraged to rank a "normal +4" number of programs. Nothing has changed, except that the "normal" number has inflated over the years. And not unsurprisingly, some students still fail to match. No system of allocating spots is going to be perfect.

 

[ZGX]

Get congress to give more residency spots.

 

[Chicago2012]

Get congress to give more residency spots.

https://www.congress.gov/bill/114th-congress/house-bill/2124?q={"search":["residency"]}