Tuesday, March 24, 2015

2015 Match Review

Continuing grim news for international med school grads and some US grads too

There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every US medical school because 93.9% of the 18,025 graduates of US allopathic medical schools matched in a specialty.

But for the 1093 (6.1%) US graduates who didn't match things were not so bright. These applicants had to go through the Supplemental Offer and Acceptance Program (SOAP) which connects unfilled programs with unmatched students.

Because there were over 8600 unmatched graduates from schools all over the world vying for about 1200 unfilled first-year residency positions, even some US med school grads did not secure a position. One of these unfortunate souls tells her story in this blog.

The 7400 or so new MDs left out in the cold will not be able to pursue their careers. They will not progress into any specialty, nor will they be able to obtain licenses to practice medicine anywhere in this country. Those with substantial tuition debt will have no way to pay off their loans.

The percentage of unmatched US graduates has been relatively stable over the last five years, ranging from 4.9% to 6.3% while the number of first-year residency positions offered has steadily increased by nearly 4000 from 23,420 in 2011 to 27,293 this year.

Graduates of osteopathic medical schools didn't fare quite as well. Of the 2949 osteopathic school applicants, 610 (20.7%) went unmatched, but this percentage has steadily declined from a high of 28.3% in 2011.

International med school grads were much worse off; 2354 (46.9%) US citizens and 3725 (50.6%) non-US citizen graduates of international medical schools did not match. Both of these groups also had declining percentages of unmatched applicants. In addition, about 1900 US citizen graduates of offshore schools either withdrew or did not submit a rank list compared to almost 2700 non-US citizen international graduates who did likewise.

Reentering the match next year is an option, but spending a year outside of clinical medicine greatly reduces one's chances of finding an accredited position.

If you factor in the number of applicants who either withdrew from the match for did not submit a rank list. graduates of international medical schools have well below a 50% chance of matching.

In previous posts here and here, I have warned about the risks involved with attending an offshore medical school. If you are considering attending such a school, I urge you to look at the numbers and think long and hard about your decision.

Source: Advance Data Tables 2015 Residency Match


Anonymous said...

One note - most of the unmatched osteopathic students likely matched to AOA training programs. The net unmatched DO rate is substantially lower than 20%.

qtipp said...

Are DO students allowed to participate in the DO match, obtain a spot and then subsequently participate in MD match? What happens if they match in the DO match (which comes first) and then also match in the ACGME match which follows? They would have to give up a position and, from what I have heard, ACGME doesn't like that one bit (and I would suspect the AOA doesn't like it either).

This page from the AOA suggests that there is a legally binding contract that results in students being removed from one match after successfully matching in the AOA:
AOA agreement
If, as this page suggests, successful matches to osteopathic programs are subsequently withdrawn from the NRMP match then those DO students who don't end up matching in the ACGME match did not match anywhere.

I could be wrong and hoping someone will shed more light.

Anonymous said...

qtipp -

Same anonymous as above, here (@ryangamlin for the record, but I can't sign in with twitter and don't want to sign in with google)

while your logic is right, you missed a step of match math, so I decided to check it for myself.

The DO match is first, and binding, as you pointed out. This means that the proportion of DO students entering the ACGME match is some fraction of total DO students that chose not to apply AOA. What is that fraction, I wondered?

Using this page (https://natmatch.com/aoairp/stats/2014sklstats.html), we find that the total non-match rate for DO seniors is something like:

12% (AOA non-match rate) + 20% x 50% (ACGME non-match rate x AOA non-participation rate) = ~22%

Which, of course, is pretty near where this whole thing started, except now a bit more sophisticated. Bad news all around.

My school (top 40 MD) had a non-match rate double the historical average. It's a terrifying time to be a medical student

Skeptical Scalpel said...

Thank you both for the clarifications. I agree that it's not a good time to be a medical student, especially if you failed a course, have a low USMLE Step 1 score, or are a student at an international school.

William Reichert said...

Is this because the number of positions available has gone down?
I believe that some programs are hurting due to a decrease in government support. Is that a factor.? Is this because the schools are
accepting less qualified students ? OR are there now too many med schools and too few training programs.

Skeptical Scalpel said...

No, the number of available positions has increased by about 4000 over the last 5 years.

There are too many schools both old and new and not enough positions for every graduate.

Anonymous said...

There are a good number of hospitals with millions of dollars in the kitty. They are "non profit corporations" that act no different than taxable corporations. Stop asking the taxpayer to do it and get these hospitals to do it. Of course, I'd like them to stop crapping on healthcare personnel but I doubt I'd see that either.

Skeptical Scalpel said...

I have always said that the minute the government cuts back on the funding of residency programs, you will see hospitals drop teaching like a hot potato.

artiger said...

This is a mess that will take years, maybe decades or even a generation to sort out. Meanwhile there will be a lot of casualties amongst graduating medical students. I wonder how long it will be before medical school applications decline.

Anonymous said...

I'd ask the hospitals where they were expecting to get their doctors from? If they say residents aren't worth the training, then maybe doctors (with few exceptions) don't need to work there. Not everyone needs hospital privs. That would allow doctors to form their own groups and hospitals couldn't throw 3-5 layers of "management" and other forms of perverse "incentives" on doctors. I would also vote that if hospitals do away with the teaching/residency programs, then dump their tax exempt status. Tie it into that, bet you'd see them shut up pretty quickly.

Skeptical Scalpel said...

It took law schools a few years before they saw drastically declining applications. See http://skepticalscalpel.blogspot.com/2013/02/law-school-applications-are-way-down.html

Anon, you may have something there. But I think the feds would rather get completely out of subsidizing hospitals to train doctors and let the hospitals and medical profession figure it out.

artiger said...

"But I think the feds would rather get completely out of subsidizing hospitals to train doctors and let the hospitals and medical profession figure it out."

Scalpel, I wish the feds would take that approach with so many other things too.

Anonymous said...

Skeptical, long time fan of your blog. I was one of those foreign grads working hard and anxiously hoping to match into surgery. I did very well in school and the steps, and worked hard on US rotations. Still, it was an uphill battle, and I learned a lot about myself throughout the process. I was fortunate to match into a categorical surgery position this year. There are success stories out there, but by and large, its a tough road for a foreign grad. Appreciate your thought provoking posts and will continue to follow you as I enter the surgical field.


Skeptical Scalpel said...

Tony, congratulations on your success. I am interested in this subject. Can you email me the name of the school you graduated from and what sort of program, community or university, you matched with? I will not disclose either specific piece of information. SkepticalScalpel (at symbol) hotmail (dot) com. Thanks.

-STEPHANIE said...

Heartbreaking to read the blog post linked in your post. It makes me feel even more thankful for how our somewhat similar situation has turned out. Thanks for continuing to post about the realities of this career path for both AMGs and IMGs alike.

Skeptical Scalpel said...

Stephanie, thanks for commenting. I plan to continue to follow the issue. I wish that more people who have not match would speak up. There must be a large number of them. We need to know what they end up doing. It might help others to decide about going to med school.

Mike said...

13,276 graduates competed for roughly 1,000 unfilled medical residency positions in the 2014 SOAP process. After the SOAP process was over, 1,500 U.S. senior MD graduates, 900 previous U.S. MD graduates, 610 US DO graduates, 3,630 U.S. citizens graduates from foreign schools, and 5,600 non-citizens graduates from foreign medical schools could not find a position. Official results for 2015 have not been released, but I expect them to be even worse than last year.

Match figures normally only include "active" applicants witch doesn't include those who withdrew from the match or the graduates who did not get at least one interview. For first time U.S. graduates, most students get multiple interviews, but over 3,008 foreign applicants and 224 previous U.S. seniors applied for the match and did not get any interviews. If you include the number of students who did not obtain an interview to the "active" applicants, the "real" match rates are 37% matching for previous U.S. grads and around 40% matching for foreign grads. The figure of 7400 doctors being left out in the cold is probably around 5,000 too low. It is a terrible time to be a foreign student and an even worse time to be a poor performing U.S. student.

Skeptical Scalpel said...

Mike, thanks for a more in-depth analysis than I could provide. It's a real problem. I've been accused of being biased against Caribbean schools. It's not bias. It's data.

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