By Marlene Welch, MD
I was not sure I wanted to go to medical school. As an undergraduate studio art major, I worried about make a living sculpting and print-making—the typical starving artist. Naively, I believed that medicine was a sure thing. I thought if I could get into medical school, I would be guaranteed a residency and a stable career as a physician. So I applied.
When I entered medical school in 1989, there were 748 more residency positions than applicants (19,955 positions for 19,207 applicants). But by the time I registered for Match Day in 1994, the odds had changed: There were 1,580 more applicants than residency positions (22,352 applicants for 20,772 positions). Fortunately, 93 percent of United States medical school seniors matched, and I was able to match into a surgical residency.
Fast-forward 18 years. In 2012, a record-high 38,377 applicants registered for Match Day for 26,772 open residency positions—over 18,000 more applicants than positions available. Of these applicants, 16,527 were senior medical students in the United States. Their match rate was 95.1 percent, also a record high. There were only 815 unmatched United States seniors, which was the fewest in almost a decade.
In 2013, the National Resident Matching Program (NRMP) will adopt the “All-In Policy,” whereby any program participating in the Match must register all of their positions through the Match. The effect of the new policy should add up to 1,400 new positions; however, this will be offset by the increased number (1,200 more expected) of medical school seniors in the 2013 Match.
As career advisors for medical students, how do we advise our students about these trends? When advising medical students at risk for not matching, we must also be prepared with data. The NRMP provides the “Charting the Outcomes of the Match” document, which serves as a guide for students and advisors to assess the likelihood that a student can match in his or her preferred specialty. Additionally, we need to factor in the less competitive applicant reaching for the highly competitive specialty. While no one wants to deny someone their dream of becoming an orthopedic surgeon, it is critical that an alternate plan is in place.
My recent attendance at the 2012 Association of American Medical Colleges (AAMC) Careers in Medicine roundtable brought up some approaches that some medical schools are implementing to address the issue of unmatched students. Several medical schools are proactively contacting the students who either failed Step I on their first attempt or passed with a marginal score. Other medical schools have compiled extensive school-specific match information that they share with their students to assess their chances for matching in a particular specialty. Of course, unmatched students have the opportunity to do research or enter graduate school, then reapply the subsequent year. Unfortunately, the match results for these graduates are as low as 40 percent.
While we remain hopeful about 2013 after the record-breaking Match Day in 2012, we know that, historically, approximately 1,500 United States fourth-years and graduates will be unmatched. We will need to be anticipatory about who is at-risk and support them with concrete opportunities for alternate plans. If a student does not secure a residency position, even after a placement through the Supplemental Offer and Acceptance Program (SOAP), the options are limited. Some students pursue research or additional degree programs, such as an MPH or MBA. A few states may allow medical school graduates to take Step III and apply for a medical license without residency training, but these opportunities are not common.
Ultimately, the onus is on us as career advisors to identify at-risk students and provide them with objective data and present them with alternate opportunities. Unfortunately, as the competition for limited training positions becomes steeper, we might see an increase in the number of medical school graduates who will not be able to complete residency training.
— Marlene C. Welch, MD, PhD, FACS is Chief, Division of Plastic Surgery, University of Toledo Medical Center; and Assistant Dean for Student Affairs, University of Toledo College of Medicine. She can be reached at firstname.lastname@example.org.