By Marlene Welch, MD
One year ago, when I wrote my first Wing of Zock post, “Matching the Unmatched: The Role of the Medical School Career Advisor,” I never expected that it would be the second most popular of 2013. Obviously, the fate of the unmatched student is on the minds of many of us in academic medicine. In that post, I outlined some proactive strategies used by medical student career advisors, including identification of “at risk” students, data-driven advising to reverse the mismatch of the less competitive applicant and highly competitive specialties, and the use of alternative plans and back-up plans. Plans for students who did not match included delaying graduation, entering graduate programs such as MBA and MPH programs, and identifying research fellowship opportunities.
One year later, there has been much discussion about the unmatched student, including in three sessions at the Careers in Medicine Professional Development Conference, numerous publications in the academic medicine literature, and even several articles in the lay press. Many of the themes were the same strategies I discussed last year: identify those at risk, provide data, and present alternatives. But I have seen several new suggestions in the past year.
What else can at-risk students do? Based on the annual NRMP Program Directors Surveys, the most important factors when ranking applicants are interpersonal skills and interactions with faculty and residents during the interview. While Step scores, grades, letters of recommendation, and the personal statement are important for getting interviews, the interview day is most important for program rankings and presumably for students matching. Thus, preparing students for interviews and practicing interview skills is an area that has been mentioned frequently. In particular, when highly qualified students with many interview offers unexpectedly do not match, the interview day is often identified as a potential area of concern along with the quality of the letters of recommendation.
What else can medical student career advisors do? While many schools have utilized proactive strategies to identify at-risk students, some schools have created extensive databases of recent match data to provide school-specific historical information about where their students have matched. This data can be used to direct students toward specific programs who have previously matched their students, or even away from programs where their students have not matched.
Earlier advising interventions in the fourth year, when students are identified who have limited numbers of applications or very few interviews, can be helpful to redirect these students to broaden their applications and manage their expectations about the possibility of not matching.
According to the 2013 NRMP match data, fewer than 50 percent of family medicine and internal medicine programs were filled by U.S. seniors and over 200 positions in family medicine and internal medicine were unfilled. Preparing students to consider these available positions in the Supplemental Offer Acceptance Program (SOAP) may decrease the number of post-SOAP students who are unmatched; there were 526 unmatched students after SOAP in 2013.
What can medical schools do? In my 2013 post , I suggested that we may see an increase in the number of medical school graduates who will not be able to complete residency training. I hesitate to even suggest that we need to manage the expectations of incoming medical students. In the increasingly competitive residency market, should we continue to graduate U.S. medical students who will not be able to compete with the highly qualified international medical graduates and D.O. students? Are we unfairly burdening these students with financial debt that they will never be able to repay if they have little hope of completing residency training? While the Training Tomorrow’s Doctors Today Act and the Resident Physician Shortage Reduction Act of 2013 could increase residency training positions, there is no guarantee that U.S. medical students will match into these positions.
Perhaps we need to reconsider alternative careers for M.D. graduates. Numerous opportunities are advertised specifically for unmatched medical students. Some companies offer nonclinical careers for M.D. graduates without residency training, including opportunities in research, industry, consulting, teaching, medical case management, and electronic medical record development, to name a few. If we are educating and graduating more medical students than we can train, then let’s think outside the box to generate new career options for M.D. graduates.
In 2013, with the All-in-Policy, there were more residency training positions, but there were also more U.S. medical students in the Match. The overall match rate dropped compared with 2012, and there were nearly 1,100 unmatched U.S. seniors and over 750 unmatched U.S. graduates. While increasing the number of residency training positions may be part of the answer, there are a lot of difficult questions that we in academic medicine must face about the number and quality of the U.S. medical school graduates and our obligation to provide them with the residency training they need to become practicing physicians.
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.