Main Residency Match...Main Residency Match PGY-1 Match Rate by Applicant Type FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE 93.9 45.4 84.6 59 58.6 0% 10% 20% 30% 40% 50% 60% 70% 80%

Main Residency Match:Is It Becoming More Competitive?

MONA M. SIGNER

LEARN SERVE LEAD

NOVEMBER 10, 2019

Main Residency MatchActive Applicants and PGY-1 Positions

FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE

16,070 16,559 16,527 17,487 17,374 18,025 18,187 18,539 18,818 18,925 19,125

1,3561,364 1,317

1,487 1,6621,520 1,502 1,472 1,511 1,485 1,450

2,0452,178 2,360

2,677 2,7382,949 2,982

3,5904,617

6,001 6,500

3,6953,769 4,279

5,095 5,1335,014 5,323

5,069

5,075

5,0805,100

7,246 6,6596,828

7,568 7,3347,366

7,4607,284

7,067

6,8696,850

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

US MD Seniors Prior US Grads DOs US IMGs IMGs Others PGY-1 Positions

13,269 More PGY-1 Positions Than Active MD Seniors in 2019

Main Residency MatchPGY-1 Matches by Applicant Type


14,992 15,588 15,712 16,390 16,399 16,932 17,057 17,480 17,740 17,763

608599 557

607 798 662 732 677 663 674

1,4441,561 1,764

2,002 2,127 2,338 2,3962,933

3,7715,076

1,7491,884 2,100

2,691 2,7222,660 2,869

2,7772,900

2,997

2,8812,721 2,770

3,556 3,633 3,641 3,7693,814

3,962

4,028

8,795 8,2048,431

9,091 8,5838,653

8,6408,281

8,0637,826

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

US Seniors Prior US Grads DOs US IMGs IMGs Others Unmatched

Number of Unmatched Applicants Declined for 4 Consecutive Years

Main Residency MatchPGY-1 Match Rate by Applicant Type


93.9

45.4

84.6

5958.6

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

US MD Senior Match Rate Steady at +/-94%

US MD Seniors

DO Physicians

US IMGs

IMGs

Prior US MD Grads

Main Residency MatchUS MD Seniors Matched to PGY-1 Positions


14,992

17,763

1,078 1,162

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Matched Unmatched

2,771 More MD Seniors Matched Since 2010

US MD Seniors in SOAP2012-2019


1,816

605 600

337

2,076

595 602 591

2,051

609 623

506

2,142

653 645606

2,199

665 666615

2,140

610 633570

2,146

581 609 620

1,916

663 684623

0

500

1,000

1,500

2,000

2,500

SOAP Eligible Offers Accepted Unique Applicants With Any Offers No Position Post-SOAP*

SOAP 2012 SOAP 2013 SOAP 2014 SOAP 2015 SOAP 2016 SOAP 2017 SOAP 2018 SOAP 2019

*All SOAP Eligible seniors who did not have any position at the conclusion of SOAP, regardless of whether they submitted a ROL.

US MD Seniors’ Match Rates By Preferred SpecialtyMost Match to Their First-Choice Specialty


75 76 77 77

83

89 8990 91 91 91

94 95 96 97 97 98 98

8481 82

8684

78

9088

84

92

9996 96 97

93

99

9397

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2016 2019

Percent Programs Citing Each Factor: Interview Selection


37%

41%

46%

47%

50%

52%

53%

54%

54%

56%

58%

59%

60%

61%

65%

65%

67%

68%

69%

70%

70%

76%

78%

80%

81%

86%

94%

0% 25% 50% 75% 100%

Applicant flagged with match violation by NRMP

Demonstrated involvement in research

Honors in clerkship in desired specialty

Gold Humanism Society membership

Graduate of highly regarded U.S. medical school

Honors in clinical clerkships

Gaps in medical education

Volunteer/extracurricular experiences

Consistency of grades

Passing USMLE Step 2/COMLEX Level 2 PE

Other life experience

Perceived interest in program

Alpha Omega Alpha membership

Leadership qualities

Audition elective/rotation within your department

Evidence of professionalism & ethics

Grades in clerkship in desired specialty

Personal prior knowledge of the applicant

Perceived commitment to specialty

Any failed attempt in USMLE/COMLEX

Class ranking/quartile

Grades in required clerkships

Personal Statement

USMLE/COMLEX Step 2 score

Medical Student Performance Evaluation

Letters of recommendation in the specialty

USMLE/COMLEX Step 1 score

Source: NRMP 2018 Program Director Survey

Average Percentage Applications RejectedBased on Standardized Screening Process


25%

26%

29%

32%

32%

33%

37%

39%

43%

43%

44%

48%

49%

49%

50%

51%

52%

53%

53%

54%

60%

61%

66%

14%

19%

34%

40%

29%

33%

42%

30%

38%

40%

47%

50%

41%

51%

48%

46%

39%

50%

53%

48%

58%

61%

61%

0% 25% 50% 75% 100%

Otolaryngology

Radiation Oncology

Dermatology

Neurological Surgery

Vascular Surgery

Plastic Surgery

Thoracic Surgery

Emergency Medicine

Radiology-Diagnostic

Internal Medicine/Pediatrics

Anesthesiology

Neurology

Physical Medicine and Rehabilitation

Orthopaedic Surgery

Average for all specialties

Pathology-Anatomic and Clinical

Child Neurology

Obstetrics and Gynecology

Pediatrics

Psychiatry

General Surgery

Internal Medicine Categorical

Family Medicine

2018 2016

Source: NRMP Program Director Survey

Percent Programs Citing Each Factor: RankingIt’s All About the Interview


23%

26%

30%

30%

32%

36%

36%

38%

40%

41%

44%

45%

46%

47%

51%

54%

56%

58%

58%

59%

60%

63%

64%

65%

65%

70%

72%

78%

86%

91%

95%

96%

0% 25% 50% 75% 100%

Other post-interview contactApplicant flagged with match violation by NRMP

Demonstrated involvement in researchHonors in clerkship in desired specialty

Honors in clinical clerkshipsGold Humanism Society membership

Graduate of highly regarded U.S. medical schoolGaps in medical education

Volunteer/extracurricular experiencesConsistency of grades

Alpha Omega Alpha membershipOther life experience

Grades in clerkship in desired specialtyAny failed attempt in USMLE/COMLEX

Passing USMLE Step 2/COMLEX Level 2 PEGrades in required clerkships

Personal StatementAudition elective/rotation within your department

Personal prior knowledge of the applicantClass ranking/quartile

Leadership qualitiesPerceived interest in program

Perceived commitment to specialtyEvidence of professionalism & ethics

Medical Student Performance EvaluationUSMLE/COMLEX Step 2 score

Letters of recommendation in the specialtyUSMLE/COMLEX Step 1 score

Feedback from current residentsInteractions with housestaff during interview

Interpersonal skillsInteractions with faculty during interview

Source: NRMP 2018 Program Director Survey

Program Use of USMLE Step 1 Scores


Consider applicants who fail 1st

attempt?

30%

59%

11%

30%

58%

12%

0%

20%

40%

60%

80%

100%

Never Seldom Often

32%

67%

1%

34%

64%

2%

0%

20%

40%

60%

80%

100%

Yes, pass only Yes, targetscore

No


Exam Required for Interview?

2016 2018

Two-thirds use a target

score

88% never or seldom consider

applicants with a failure

Step 1 Scores Are Rising By Preferred Specialty


200

210

220

230

240

250

260

270

High Low 2007 Median 2011 Median 2015 Median 2019 MedianSource: NRMP Data Warehouse and AAMC Data Warehouse.

Program Use of USMLE Step 2CK Scores


Consider applicants who fail 1st

attempt?

35%

57%

8%

35%

57%

8%

0%

20%

40%

60%

80%

100%

Never Seldom Often

34%

49%

17%21%

39% 40%

0%

20%

40%

60%

80%

100%

Yes, pass only Yes, targetscore

No


Exam Required for Interview?

2016 2018

Fewer programs require

Step 2 for interviews

92% never or seldom consider

applicants with a failure

Step 2 CK Scores Are RisingBy Preferred Specialty


200

210

220

230

240

250

260

270

High Low 2007 Median 2011 Median 2015 Median 2019 MedianSource: NRMP Data Warehouse and AAMC Data Warehouse.

Percent US MD Seniors Citing Each Factor: Applications


38%

41%

46%

46%

51%

52%

53%

53%

54%

56%

56%

57%

57%

58%

61%

64%

64%

67%

68%

83%

84%

88%

0% 25% 50% 75% 100%

Cultural/ethnic diversity of geographic location

Research opportunities

Program flexibility to pursue electives

Quality of hospital facility

Diversity of patient problems

Preparation for fellowship training

Housetaff morale

Social & recreational opportunities in area

Balance between supervision & patient care

Career paths of recent program graduates

Program size

Future fellowship opportunities in the institution

Quality of program director

Cost of living

Quality of faculty

Work/life balance

Quality of curriculum & training

Quality of residents in program

Academic medical center program

Reputation of program

Perceived goodness of fit

Geographic location

Source: 2019 Applicant Survey

Percent US MD Seniors Citing Each Factor: Applications (cont’d)


4%

5%

6%

8%

13%

15%

16%

16%

20%

21%

23%

23%

24%

27%

27%

30%

33%

33%

34%

35%

35%

36%

0% 25% 50% 75% 100%

Previous Match violation

Other benefits

Schools for my children in the area

Alternative duty hours

Opportunity for systems-based practice

Having friends at the program

Quality of ambulatory facilities

Supplemental income (moonlighting) opportunities

Opportunity for international experience

Community-based program

ABMS board pass rates

Availability of electronic medical record

Salary

Vacation/parental/sick leave

Quality of ancillary staff

Size of patient caseload

Cultural/ethnic diversity at institution

Opportunities to perform specific procedures

Call schedule

Support network in the area

Future job opportunities for myself

Job opportunities for my spouse/significant other


Percent US MD Seniors Citing Each Factor: Ranking


35%

38%

42%

42%

43%

44%

44%

45%

47%

47%

48%

50%

55%

61%

61%

62%

64%

65%

71%

75%

77%

89%

0% 25% 50% 75% 100%

Call schedule

Research opportunities

Quality of hospital facility

Program flexibility to pursue electives

Social & recreational opportunities in area

Diversity of patient problems

Program size

Future fellowship opportunities in the institution

Balance between supervision & patient care

Cost of living

Preparation for fellowship training

Career paths of recent program graduates

Academic medical center program

Housetaff morale

Quality of curriculum & training

Work/life balance

Quality of faculty

Quality of program director

Reputation of program

Quality of residents in program

Geographic location

Perceived goodness of fit


Percent US MD Seniors Citing Each Factor: Ranking (cont’d)


3%

4%

4%

4%

7%

11%

13%

13%

14%

17%

17%

18%

21%

23%

24%

25%

29%

30%

31%

32%

32%

33%

0% 25% 50%

Previous Match violation

Other benefits

Schools for my children in the area

Alternative duty hours

Opportunity for systems-based practice

Having friends at the program

Supplemental income (moonlighting) opportunities

Community-based program

Quality of ambulatory facilities

Opportunity for international experience

Availability of electronic medical record

ABMS board pass rates

Vacation/parental/sick leave

Salary

Opportunities to perform specific procedures

Quality of ancillary staff

Size of patient caseload

Cultural/ethnic diversity at institution

Cultural/ethnic diversity of geographic location

Support network in the area

Future job opportunities for myself

Job opportunities for my spouse/significant other


Matched Applicants*Applications, Interviews, Programs Ranked in Preferred Specialty


115.3

126.6

55.1

57.9

45.2

7.7

9.3

11.1

7.8

12.9

7.5

9.2

10.9

7.4

12.9

0 20 40 60 80 100 120 140

Foreign

US Foreign

Osteopathic

US MDGraduate

US MD Senior

Applications

Programs Ranked

Interviews Attended

*Applicants matched to preferred or alternate specialtySource: NRMP 2019 Applicant Survey

Fewest applications;

highest ratio of interviews

& ranked programs

Matched Applicants*Applications, Interviews, Programs Ranked in Alternate Specialty


69.3

84.8

32.8

45.6

28.1

3.3

4.6

5

5.3

6.6

3.3

4.4

4.6

4.9

6.1

0 20 40 60 80 100 120 140

Foreign

US Foreign

Osteopathic

US MDGraduate

US MD Senior

Applications

Programs Ranked

Interviews Attended

*Applicants matched to preferred or alternate specialty

Source: NRMP 2019 Applicant Survey

Fewest applications;

highest ratio of interviews

& ranked programs

Unmatched ApplicantsApplications, Interviews, Programs Ranked in Preferred Specialty


95.5

94.5

64.5

64.8

65.6

2.6

2.7

5.2

3.6

7.8

2.6

3.2

5.2

4.3

7.8

-10 10 30 50 70 90 110 130 150

Foreign

US Foreign

Osteopathic

US MD Graduate

US MD Senior

Applications

Programs Ranked

Interviews Attended


Highest ratio of

interviews &

ranked programs to

applications

Unmatched ApplicantsApplications, Interviews, Programs Ranked in Alternate Specialty


65.1

70.3

27.8

31.5

44.4

1.5

1.5

2.3

1.2

4.2

1.6

1.9

2.3

1.2

3.8

0 20 40 60 80 100

Foreign

US Foreign

Osteopathic

US MDGraduate

US MD Senior

Applications

Programs Ranked

Interviews Attended


Did not rank all

programs where they

interviewed

US MD Seniors Matched and UnmatchedApplications, Interviews, Programs Ranked


44.4

65.6

37.8

45.2

4.2

7.8

8.6

12.9

3.8

7.8

8.3

12.9

0 20 40 60 80 100 120 140

Unmatched(applications,

interviews,programs ranked inalternate specialty)

Unmatched(applications,

interviews,programs ranked inpreferred specialty)

Matched toAlternate Specialty

(applications,interviews,

programs ranked inalternate specialty)

Matched toPreferred Specialty

(applications,interviews,

programs ranked infirst-choicespecialty)

Applications

Programs Ranked

Interviews Attended


+20.4 applications in

preferred specialty;

5 fewer interviews

+6.6 applications in

alternate specialty;

4.4 fewer interviews

Unmatched US MD SeniorsLower Yield Per Application, Fewer Interviews, Fewer Programs Ranked


11.6

12.0

15.3

110.0

19.0

19.5

26.6

73.3

0 20 40 60 80 100 120 140

Programs Ranked

Interviews Attended

Interviews Granted

Applications for Preferred + Alternate Specialty

Average Number of

Matched Unmatched

36.7 more

applications

11.3 fewer interview offers

7.5 fewer interviews attended

7.4 fewer ranked programs


US MD Seniors’ Ranking Behavior


3%

10%

13%

22%

52%

65%

75%

1%

4%

22%

45%

74%

68%

88%

0% 20% 40% 60% 80% 100%

Ranked one or more programs where I applied but did notinterview

Ranked programs based on the likelihood of matching

Ranked a mix of competitive and less competitivespecialties as a "fallback plan"

Ranked one or more less competitive programs inpreferred specialty as a "safety net"

Ranked all programs I was willing to attend

Ranked all programs at which I interviewed

Ranked the programs in order of my preferences

Matched Unmatched

Less likely to rank

programs in order of

preference

Less likely to rank all

programs where they

interviewed

Less likely to rank all

programs willing to attend

Less likely to rank a “safety net”

program in preferred specialty

Less likely to have a “fallback

plan” in alternate specialties

More likely to rank based on

likelihood of matching

More likely to rank programs

where they did not interview


Unmatched US MD Seniors by SchoolFive-Year Average: 2015-2019


0

5

10

15

20

0% 5% 10% 15% 20% 25% 30%

Nu

mb

er

Un

ma

tch

ed

Percent Unmatched

Average = 7.3 graduates/school

Average = 5.7% of class

Is the Match Becoming More Competitive?


13,269 more PGY-1 positions than active US MD seniors• Even so, 623 MD seniors had no position post-SOAP

• BUT, 5,076 DOs, 2,997 USIMGs, and 4,028 IMGs matched to PYG-1 positions

• Total number of unmatched applicants declined for 4 consecutive years

US MD senior PGY-1 match rate steady at +/- 94%• Little change in US MD senior match rates by preferred specialty

• Match rates for other applicants steady or rising

Step 1 and Step 2CK scores are rising

• Two-thirds of programs never/seldom consider applicants with a Step 1 failure

• 88% of programs never/seldom consider applicants with a Step 2CK failure

• Fewer programs require Step 2CK for interview

Little change in percentage of applications rejected without review

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Main Residency Match...Main Residency Match PGY-1 Match Rate by Applicant Type FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE 93.9 45.4 84.6 59 58.6 0% 10% 20% 30% 40% 50% 60% 70% 80%