Could it be that people applied EM ranked their EM places and then failed to match into EM but instead into their backup speciality? I know several people that failed to match EM at my school this year and last but i can't remember if they went AOA or ACGME
Here's a list that got posted earlier:
http://forums.studentdoctor.net/showpost.php?p=14453024&postcount=320
From what I've seen in the past, it does seem pretty well matched. I'm just concerned that I may be in that bottom 5%.
Well, I drove from So. Cal. Unfortunately, my core EM was August to September, which limited my schedule prior to that. Then Western went and futzed up my next rotation... and I slightly failed to capitalize on it (granted, I would have had about a week to throw everything together with where to drive and shadowing... but still... :-( )
Okay... long post coming. Sorry for this, but I'm sifting through a lot of data because that's what I do when I'm tired and stuck on something.
First of all, let me apologize for misreading the data. I read about the relatively even ratio in
this excellent guide written last year, and when I skimmed the
2011 AOA GME Match Report, I guess I saw what I wanted to based on my preconceived notions. Upon rereading the report, it looks like there is
not such a close ratio of positions to applicants. So my revised assessment of the DO EM match:
- There were 317 applicants who listed EM as their first choice.
- There were 216 EM PGY-1 positions available.
- 209 applicants who listed EM as their first choice were matched into an EM program.
- 5 applicants who listed a different specialty as their first choice were matched into an EM program.
- The remaining 2 positions are unaccounted for; I'm not sure if they were filled in the scramble or left unfilled.
- The remaining 103 applicants who listed EM as their first choice are also unaccounted for; I'm assuming they either matched into a combined program or a 'fallback' specialty, or scrambled, or went to the MD match, or couldn't find anything at all.
- Combined FM/EM: 7 positions, 9 ranked it as their first choice. 4 of those 9 matched FM/EM; the other three positions were filled by applicants who ranked other specialties first.
- Combined IM/EM: 20 positions, 15 ranked it as their first choice. 9 of those matched IM/EM; 3 other positions were filled by applicants who ranked other specialties first, while 8 positions remained unfilled. 😕
So as of two years ago, out of everyone who put an EM program at the top of their rank list, about two thirds matched into an EM program, along with five people who didn't have EM at the top. There's probably some mingling with the combined programs (some of those five probably ranked those first, and those who ranked a combined program lower but matched there were probably EM-focused applicants).
Now, it's possible that some of these people liked EM enough to rank it first, but had other specialties that they were interested in, as well. The report discusses the number of consecutive programs in a specialty ranked by applicants who matched in that specialty:
- While EM-specific data are not given, in general, applicants who matched into a specialty other than their first choice only ranked 2.12 programs in their top specialty before ranking programs in a different specialty.
- The successful EM applicant ranked an average of 4.52 EM programs at the top of their list before either ending their list or ranking a program in a different specialty. This is more programs ranked than the average across all specialties (3.52).
- Those who did not match anywhere (applicants to all specialties) ranked only 3.25 programs in their top-choice specialty.
So if you're really set on EM, it's to your advantage to rank a lot of programs, but it might not be that much of an advantage.
How will things look this year? It's hard to say, and missing the last two years of data makes it hard to predict a trend (glares at AOA/NMS). However, a few trends to consider, with limited data from
here:
- From the post above, there are 6 new DO EM programs starting in 2013, with about 37 new positions. This gives a total of about 259 positions (20% increase vs. 2011).
- No EM-specific data, but overall, in 2011 there were 2212 applicants to NMS.
- In 2013 there were 2512 applicants to NMS, a 14% increase over 2011.
So while there are more spots available this year, that is partially offset by an increase in the overall number of applicants. EM is also becoming more popular, which might further increase the number of applicants to the specialty. How much is it growing? Well, we're off to
another source, this one from the NRMP. Who provides much more detailed information. And doesn't have to spend a year and a half putting together the damn report. Anyway, it's not NMS data, but it presumably reflects a similar shift in the popularity of EM:
- In 2011, there were 1607 EM spots in the NRMP. 2230 applicants ranked at least one EM program.
- 177 DOs matched into ACGME EM programs.
- In 2013, there were 1744 EM spots in the NRMP. 2430 applicants ranked at least one EM program.
- 178 DOs matched into ACGME EM programs.
So on the MD side, there was a 9.0% increase in applicants to EM, while the number of positions grew by 8.5%. So a small increase, and proportionate to the number of available positions. This is relative to a 12% overall increase in NRMP participation since 2011. So the increase in interest in EM is about 75% of the overall increase in applications.
I'm seeing one last question: is there an effect caused by DOs shifting from the NMS to the NRMP when seeking EM positions? It's hard to say, as the number of DO applicants to MD EM isn't listed. However, on all-specialties level, NMS lists "non-participants" (a low estimate, as it doesn't include those participating in both matches), and NRMP lists "Independent Applicants" (a very high estimate, as it includes FMGs). Still:
- NMS claims 2114 non-participants in 2011, vs. 2484 in 2013 (18% increase).
- (The proportion of non-participants has fluctuated between 46-49% over the last 5 years; it's hard to see this number have a drastically different effect than in years past.)
- NRMP claims 2178 DOs in the match overall in 2011, vs. 2677 in 2013 (23% increase).
- NRMP shows 748 IAs to EM in 2011, vs. 790 in 2013 (5.6% increase).
So while the overall number of DOs participating in NRMP has increased by about 20%, the number applying for EM has increased only slightly. My guess is that DOs are realizing how tough it is to get into EM from this side of the fence, and are focusing on getting into AOA programs instead. That may mean an increase in the number of applicants to DO EM greater than expected. Alternate hypotheses include FMGs giving up on EM completely and the possibility that EM's popularity is inexplicably lower among DO students. Regardless, this effect is hard to quantify.
Okay... enough of that crap. Let's run some numbers. How many positions are we looking at, and how many applicants?
Positions we covered. Looking at 259, give or take a few. Hopefully give, as established programs may have expanded.
Applicants: We'll start with the number of applicants in 2011 (317). Increase it by our projected overall growth in the number of DO applicants (14% in two years, assume 21% in three). Assume the growth rate in EM interest is about 3/4 that of the overall growth rate, based on projection from NRMP data.
317 + {[(3/4) x 0.21] x 317} = 367 applicants
So we're looking at about 367 applicants. Maybe that number goes a little higher if it's true that fewer DOs are seeking ACGME opportunities in EM relative to other specialties, and wind up applying to AOA programs instead. Let's just call it an even 375.
So our revised numbers are about 375 applicants for about 259 spots, for a potential match rate of 69%. So it looks like with the new programs, our chances are actually slightly better than they were a couple years ago.
Takeaways:
- I am tired.
- The recent burst of new programs will likely outweigh the potential increase in applications.
- EM is still less competitive than almost any other specialty that fills all spots.
- We're not quite sure what happens to the 30% who rank EM first but don't match in it.
- Rank a lot of programs and nail your interviews.
- NMS/AOA need to hire an intern who knows how to use Excel. No excuse for not having 2012 data out by now, or even 2013 at this point.
