Match Performance 2015

[re33t]

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Is the data out on how the Caribbean schools' students have done this match cycle?

Can any Caribbean students share their experience?

 

[crotchrocketer]

SGU
Ross
AUC

These seem to have quite comparable match lists to years past (numbers and specialties).

AUA

Match list seems less favorable at first glance than years past. Hardly anything outside of primary care (not saying this is a bad thing for healthcare overall).

SABA and MUA

Have not yet reported as far as I know.


And the rest...well who really cares right? [emoji56]

The great residency crunch has not happened yet...well at least in 2015 and at least in my opinion.

 

[piyalis]

Results From The 2015 GME Matches: GME Positions Continue To Grow

Recently the preliminary results from the 2015 National Resident Matching Program® [1] (NRMP®) and the American Osteopathic Association [2] (AOA) Match were released. While final Match data from the NRMP will be released later this spring, the preliminary results from both programs provide important insights on Graduate Medical Education (GME) trends of interest in the policy community. Three issues are of particular interest in the policy community:

1. Are GME positions continuing to grow? While many people thought that GME positions would not increase after the Medicare program capped the number of positions the program would pay for in 1997, studies tracking GME through 2010 showed that GME positions continued to grow at about 1 percent per year [3]. With new financial pressures on hospitals, will this growth end or even reverse?
2. How does the number of entry-level GME positions compare to the number of US graduates (MD and DO)? With the number of US graduates growing rapidly due to increases in enrollment and new schools coming on line, are there sufficient GME positions for all graduates?
3. Are more physicians, particularly US graduates, selecting primary care specialties? A number of new programs and incentives in the Affordable Care Act were in response to calls for an increase in the number of physicians going into primary care. Is there any indication these incentives are working?

Data Sources
GME matching programs are the connection between medical education and graduate medical education in the training pipeline. GME is a prerequisite to becoming licensed and practicing medicine in the US and is a key determinant of the size and specialty distribution of the future physician workforce.

Before reviewing the 2015 results of the two major matching programs (See Note 1 [4]), a word on the data sources is in order. In 2013 the NRMP instituted what is known as the “all-in” policy, which required participating programs to include all of their positions in the matching program. This led to an increase in positions available through the NRMP. Nearly all entry level ACGME accredited training positions are now in the NRMP Main Residency Match®. The ACGME will provide the authoritative data for entrants into programs they accredit, but data for 2015-16 training year (covered here) will not be available until fall of 2016. It appears that the NRMP and AOA Matches include about 95 percent of the accredited GME positions available to new entrants into GME. (See Note 2 [5])

Highlights Of The 2015 NRMP And AOA Match Results
First year positions (PGY 1 positions) for entrants into GME reached an all-time high and the number continues to grow.
This year, a record 27,293 first year positions were offered (See Note 3 [6]) by the NRMP (an increase of 615 over 2014) and an additional 3,118 first year positions were offered in the AOA-sponsored Match (an increase of 120 over 2014), for a total of 30,411 first-year positions in 2015. This represents an overall increase of 2.5 percent from 2014. Although this was the third year of the NRMP all-in policy, it is still possible that some of the NRMP growth reflects its continuing implementation.

Entry level GME positions far surpass the number of US MD and DO graduates seeking a residency position.
Despite a lot of rhetoric and fear that new US graduates are facing a lack of training slots, overall there were about 23,000 US MD and DO graduating seniors competing for the 30,411 first year positions in the two major matching programs. Some additional positions were available through the smaller urology and ophthalmology matching programs, but they are not entry-level slots.

The number of graduates of foreign medical schools continues to be significant.
More than 6,300 International Medical Graduates (IMGs) were matched into ACGME programs. (See Note 4 [7]) Between 2014 and 2015, there was a very small decrease in the number of IMGs matched through the NRMP. However, some IMGs may still be entering programs outside the Match. Of the IMGs matched through the NRMP in 2014, 2,660 (42 percent of the total IMGs) were US citizens who had graduated from foreign medical schools, a slight decrease (2 percent) from 2014. The number of non-US IMGs remained unchanged.

Some MD seniors were not matched in the Main Residency Match.
For MDs, 1,093 of 18,025 active senior participants were not matched in the Main Residency Match, compared to 975 in 2014. There is an opportunity to obtain a position in a process called the Supplemental Offer and Acceptance Program (SOAP), which allows unmatched applicants to try to obtain an unfilled residency position during the few days following release of preliminary applicant and program results.

In 2015, there were 1,041 entry level positions unfilled after the matching algorithm was processed. While this is very close to the 1,093 senior MDs who were not matched, several thousand unmatched DOs, IMGs, and other US MDs (non-seniors) were also competing for those 1,041 unfilled positions. In 2014, of the 975 senior MDs unmatched after the main match, only 412 had no position (2 percent of all seniors) after SOAP. Those who remained without positions were also eligible to apply again in 2015.

Some DO graduates did not get matched in the main matches.
The AOA-sponsored Match occurs prior to the NRMP Match. As a result, the figure for osteopathic seniors who do not match is less clear as they can also apply to ACGME programs through the NRMP. A total of 610 DOs who participated in the NRMP were unmatched, but they too could compete for the 1,041 positions available in SOAP, as well as for unfilled AOA accredited positions.

What The Numbers Tell Us
Are GME positions continuing to grow?
Despite the financial pressures on teaching hospitals, GME positions continue to increase. As noted above, entry positions grew 2.5 percent between 2014 and 2015. This is not to say that GME positions will continue to grow, but at this point there are no signs of a turn-around. This continued growth may reflect funding from states and directly from teaching hospitals. It may also reflect some new federal funding, such as for Teaching Health Centers.

Are there enough positions for US seniors?
A number of groups have suggested that the nation needs to expand GME funding in order to increase GME slots to assure that all US MD and DO graduates are able to complete the training required to become a licensed physician. The argument is that the number of MD and DO graduates is growing faster than GME entry slots and that eventually there will be more graduates than entry level residency positions. Based on the Match data, it is clear that there are currently far more entry level positions than graduates. Over 6,300 IMGs were able to obtain positions. There were far more available positions than US MD and DO graduates seeking positions.

Although there are a variety of reasons why MD graduates do not obtain positions, it is not because the number of positions is insufficient. Some do not match because of academic problems. Others do not match because their sole specialty selection was a very competitive one. For example, final figures for 2014 show that 721 US seniors selected only orthopedic surgery; unfortunately, there were only 695 orthopedic positions available and many non-US senior applicants also competed for them.

Primary Care Trends
For both MDs and DOs, the overall number of positions offered in primary care specialties continued to increase. Combining data from the NRMP and the AOA match, in family medicine, where the vast majority of residents will go on to practice primary care, the number of positions offered was up 5.5 percent from 2014 to 2015 and the number of US graduates selecting family medicine was up 6.5 percent. For internal medicine and pediatrics, a significant percent of physicians starting training in these specialties will go on to sub-specialize or to become hospitalists, perhaps as high as 60 percent. Thus the Match numbers may not be a good predictor for primary care. Nevertheless, it is encouraging that the number of entry positions offered in internal medicine was also up in both Matches as was the number of US graduates selecting those specialties. The number of positions offered in pediatrics was basically flat.

For a more refined assessment of the numbers graduates entering primary care, it is possible to compare the numbers completing training in family medicine, internal medicine, and pediatrics to the numbers who also enter sub-specialty training. Extensive data on sub-specialization in allopathic training positions is available from the ACGME and the NRMP Specialties Matching Service® (SMS®) results. While this methodology has its shortcomings, including the inability to identify physicians who become hospitalists, it does provide a better picture than the Matches sponsored by the NRMP and the AOA. I will save that analysis for a future post.

Note 1
The two major matching programs are: the NRMP for training positions accredited by the Accreditation Council for Graduate Medical Education (ACGME), that matches medical doctors (MDs), doctors of osteopathic medicine (DOs) and graduates of schools outside of the US, known as international medical school graduates (IMGs); and one for GME programs accredited by the American Osteopathic Association (AOA) that is limited to DOs.

Note 2
Not included in this data are physicians entering training through the military matches, the San Francisco match and individuals entering ACGME programs that are not using the NRMP. Based on historical data, I estimate this to be between 1,200 and 1,500 positions.

Note 3
While “offered positions” may exceed the final filled positions, given that these positions are being offered in the Match they are available to US seniors and others seeking residency positions. Further, final filled positions will not be publically available for ACGME accredited programs for another 18 months or so; and final AOA filled position numbers have not generally been published.

Note 4
US MDs and IMGs are not eligible for AOA accredited training programs.

http://healthaffairs.org/blog/2015/05/01/results-from-the-2015-gme-matches-gme-positions-continue-to-grow/