How Competitive is the Match?

How Competitive is the Match? Mona M. Signer President and CEO November 13, 2016 Reproduction prohibited without the written permission of the NRMP. ...
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How Competitive is the Match? Mona M. Signer President and CEO November 13, 2016 Reproduction prohibited without the written permission of the NRMP.

Main Residency Match PGY-1 Positions Offered and Filled 6,015 More Positions Since 2007 All In Policy

40,000 35,000 + 567 PGY-1 positions over 2015

30,000 25,000 20,000 15,000 10,000 5,000 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Offered

Filled

Filled US Seniors

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Active Applicants 162 More Seniors, 571 More Active Applicants 7,532 More Applicants Since 2007 All In Policy

40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 2007 Others

2008

2009

DOs

2010 IMGs

2011

2012

US IMGs

2013

2014

Prior US Grads

2015

2016

US Seniors

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PGY-1 Matches by Applicant Type Change Since 2007 4,000

3,000 2,856

2,000 1,522

1,000

1,260 589

158

0 US Senior

US Grad

-63 USIMG

DO

IMG

Other

-1,000

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PGY-1 Match Rates by Applicant Type Overall 2016 Match Rate: 75.6%

All In Policy

100%

US Seniors

90%

Osteopathic Physicians

80% 70% 60%

US IMGs IMGs

50%

Prior US Grads

40% 30% 20% 10% 0% 2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

Reproduction prohibited without the written permission of the NRMP.

Average Length of U.S. Seniors’ ROLs Matched and Unmatched Applicants

16 14 12 10

11.97 8.9

8 6 4

7.11 5.62

2 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Unmatched

Matched

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Match Rates By Preferred Specialty Most Seniors Match!

100% 90%

89 91 8989 89

89

80% 70%

97 98 97 96 98 95 9998 9697 96 94 96 96 97 96 94 93 91 91 91 91 90 88

85 83 77 75

76 77 77 75 79 76

71

71

60% 50% 40% 30% 20% 10% 0%

Source: Charting Outcomes in the Match

2014

2016

Reproduction prohibited without the written permission of the NRMP.

Unmatched Seniors, PGY-1 Positions in SOAP More Unmatched Seniors than PGY-1 Positions = 4 Years SOAP 2,000

1,500

1,331

U.S. Seniors With ROLs Unmatched to PGY-1 Positions

1,130

1,000 1,005

975 PGY-1 Positions in SOAP

500

0 2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

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Preferences of Unmatched Seniors Available SOAP Positions

Orthopaedic Surgery General Surgery Emergency Medicine Psychiatry Family Medicine Obstetrics-Gynecology Internal Medicine (C & M) Neurological Surgery Pediatrics Otolaryngology Dermatology Plastic Surgery Neurology Anesthesiology Physical Medicine & Rehab Internal Medicine (PGY-1 Only) Internal Medicine-Pediatrics Pathology Surgery-Preliminary (PGY-1 Only) Vascular Surgery Radiology-Diagnostic Radiation Oncology Transitional Year Thoracic Surgery Child Neurology Other

28 24 22 16 15 14 9 9 9 9 9 7 6 5 5 3

51 48

83 73 71 93

116 102

169

Available Positions Preferred Specialty

3 0

50

100

150

200

250

300

350

400

450

500

Reproduction prohibited without the written permission of the NRMP.

SOAP Positions Accepted by Applicant & Position Type 2,199

700 30

600

989 applicants accepted 1,022 positions

192

500 400 300 200

387

995

100 0

4,020

1 31 US Seniors

None Accepted

2

20 13

US Grads

PGY-1 Only

3

38 45

PGY-2 Only

0

2

USIMGs

5,871

817 68 10

55 DOs

Categorical

2

27 43

0

IMGs

PGY-1 & PGY-2

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U.S. Allopathic Seniors in SOAP 2012 - 2016 2,500

2,000

2,199 2,142 2,076 2,050 1,816

1,500

1,000

605 595 609

500

653 665

600 602

666 623 645

606 615

591 506 337

0 SOAP Eligible

SOAP 2012

Offers Accepted

SOAP 2013

Unique Applicants With Any Offers

SOAP 2014

SOAP 2015

No Position Post-SOAP*

SOAP 2016

*Presentations before 2015 included only seniors with a certified ROL who did not have any position at the conclusion of SOAP, regardless of whether they participated in SOAP. This presentation includes all SOAP-participating seniors who did not have any position at the conclusion of SOAP.

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Getting the Interview

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Applications, Interviews, Ranks Internal Medicine Categorical Family Medicine Pediatrics Psychiatry Average for All Specialties Emergency Medicine General Surgery Anesthesiology Orthopaedic Surgery Neurology Obstetrics and Gynecology Dermatology Radiology-Diagnostic Pathology-Anatomic and Clinical Physical Medicine and Rehabilitation Otolaryngology Internal Medicine/Pediatrics Neurological Surgery Plastic Surgery Radiation Oncology Thoracic Surgery Child Neurology Vascular Surgery 0 Applications

500 1,000 Interview Invitations

1,500 2,000 2,500 Applicants Ranked

3,000

Source: NRMP Program Director Survey

Reproduction prohibited without the written permission of the NRMP.

Average Percentage Applications Rejected 68%

Family Medicine

66% 62%

General Surgery

60%

61%

Internal Medicine Categorical

61%

Psychiatry

54%

58%

Pediatrics

53%

56%

Pathology-Anatomic and Clinical

51%

52%

Obstetrics and Gynecology

53%

51%

Average for all specialties

50% 49%

Child Neurology

52%

48%

Neurology

48% 48%

Internal Medicine/Pediatrics

43%

47%

Anesthesiology

44%

46%

Orthopaedic Surgery

49%

45%

Physical Medicine and Rehabilitation

49%

41%

Emergency Medicine

39%

Neurological Surgery

32%

43%

36%

Thoracic Surgery Dermatology Otolaryngology

37%

33%

29% 25%

Radiation Oncology 0%

31%

29%

Plastic Surgery Vascular Surgery

40% 39%

Radiology-Diagnostic

Source: NRMP Program Director Survey

61%

33%

27%

32%

26%

26%

25% 2014

50%

75%

100%

2016 Reproduction prohibited without the written permission of the NRMP.

Percentage of Programs Citing Each Factor in Interview Selection 94% 93% 86% 88% 84% 84% 80% 83%

USMLE Step 1/COMLEX Level 1 score Letters of recommendation in the specialty Medical Student Performance Evaluation USMLE Step 2 CK/COMLEX Level 2 CE score Grades in required clerkships Personal Statement Class ranking/quartile Perceived commitment to specialty Any failed attempt in USMLE/COMLEX Grades in clerkship in desired specialty Evidence of professionalism and ethics Personal prior knowledge of the applicant Leadership qualities Audition elective/rotation within your department Consistency of grades Passing USMLE Step 2 CS/COMLEX Level 2 PE Alpha Omega Alpha (AOA) membership Perceived interest in program Other life experience Lack of gaps in medical education Awards or special honors in clinical clerkships Graduate of highly-regarded U.S. medical school Awards/honors in clerkship in desired specialty Volunteer/extracurricular experiences Applicant flagged with Match violation by NRMP Source: NRMP Program Director Survey

70%

79% 78% 78%

69% 71% 69% 71% 70% 61%

70% 65% 70% 65% 70% 63% 66% 63% 66%

56%

64% 57% 62% 61% 61% 57% 61% 56% 59% 58% 58% 48%

34%

0% 2014

25%

70% 69%

56% 61% 54% 54% 54%

40%

50%

75%

100%

2016 Source: NRMP Program Director Survey Reproduction prohibited without the written permission of the NRMP.

Programs’ Use of the MSPE in Interview Selection 95% 97%

Child Neurology 86%

Radiation Oncology 74%

Internal Medicine/Pediatrics

93% 93% 94% 92%

Psychiatry 83%

Dermatology

91% 91% 91% 90% 90% 88% 90% 85% 88% 83% 88% 87% 86% 84% 84% 87% 84% 83% 83%

Radiology-Diagnostic Internal Medicine Categorical Physical Medicine and Rehabilitation Neurology Pathology-Anatomic and Clinical Anesthesiology Average for all specialties Pediatrics Thoracic Surgery 76%

Obstetrics and Gynecology

81% 80% 80%

Family Medicine Emergency Medicine General Surgery Neurological Surgery

73%

Orthopaedic Surgery

73% 70% 71% 74% 70%

Vascular Surgery Otolaryngology

91%

79%

62% 63%

Plastic Surgery 0%

79% 79% 78% 81%

2014

25% 2016

50%

75%

100%

Source: NRMP Program Director Survey Reproduction prohibited without the written permission of the NRMP.

Percentage of Programs Using USMLE Step 1 Scores for Interview Selection Consider applicants who fail 1st attempt?

Scores Required? 100%

100%

80%

80%

68 67

60%

60%

40%

63

59

40%

31 32 20%

26

20%

11 11

1

1

0%

30

0% Yes, pass only

Yes, target score

No

Never 2014

2016

Seldom

Often

Source: NRMP Program Director Survey

Reproduction prohibited without the written permission of the NRMP.

Step 1 Scores Are Rising By Preferred Specialty

270 260 250 240 230 220 210 200

2007 Median

2011 Median

2014 Median

2016 Median

Source: NRMP Data Warehouse and AAMC Data Warehouse.

Source: Charting Outcomes in the Match Reproduction prohibited without the written permission of the NRMP.

Percentage of Programs Using USMLE Step 2 CK Scores for Interview Selection Consider applicants who fail 1st attempt?

Scores Required? 100%

100%

80%

80%

60%

60% 58 57 50 49

40%

40% 31

35 35

34

20%

20% 19 17

0%

6

0% Yes, pass only

Yes, target score

No

Never 2014

2016

Seldom

8

Often

Source: NRMP Program Director Survey

Reproduction prohibited without the written permission of the NRMP.

Step 2 CK Scores Are Rising By Preferred Specialty

270 260 250 240 230 220 210 200

2007 Median

2011 Median

2014 Median

2016 Median

Source: NRMP Data Warehouse and AAMC Data Warehouse.

Source: Charting Outcomes in the Match Reproduction prohibited without the written permission of the NRMP.

Factors in Ranking Applicants It’s All About the Interview: 2016

Interactions with faculty during interview

95%

Interpersonal skills

95%

Interactions with housetaff during interview

90%

Feedback from current residents

86%

USMLE Step 1/Comlex Level 1

78%

Recommendation letters in specialty

73%

USMLE Step 2 CK/Comlex Level 2

72%

MSPE

68%

Perceived commitment to specialty

67%

Evidence of professionalism

67%

Perceived interest in program

64%

Personal prior knowledge of applicant

60%

Leadership qualities

59%

Class rank

58%

Audition rotation within department

58%

Personal statement

57%

Grades in required clerkships

57%

0%

25%

50%

75%

100%

Source: NRMP Program Director Survey Reproduction prohibited without the written permission of the NRMP.

Factors in Ranking Applicants It’s All About the Interview, cont’d Passing USMLE Step 2 CS/Comlex Level 2

53%

Grades in clerkship in desired specialty

50%

Any failed USMLE/COMLEX

47%

Consistency of grades

47%

Alpha Omega Alpha

46%

Other life experiences

46%

Graduate of highly-regarded U.S. allopathic…

41%

Lack of gaps in medical education

41%

Volunteer/extracurricular experiences

40%

Awards/honors in clinical clerships

38%

Awards/honors in clinical clerships in desired…

36%

Gold Humanism Honor Society membership

34%

Involvement in research

32%

NRMP Match violation

28%

Visa status

26%

Interest in academic career

25%

Second interview/visit

22%

Awards/honors in basic sciences

21%

Fluency in patient-spoken language

21%

Away rotation in your specialty

20%

USMLE Step 3/COMLEX Level 3 score

19%

Other post-interview contact

18%

0%

25%

50%

75%

100%

Source: NRMP Program Director Survey Reproduction prohibited without the written permission of the NRMP.

Average Ranks Per Position Filled and Unfilled Programs

16 14 12

11.99 9.96

10 8 6 4 2

7.54 4.97

0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Unfilled Programs

Filled Programs

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How Competitive is the Match? 

9,600 more PGY-1 positions than active seniors in the Match



No change in U.S. seniors’ PGY-1 match rate   

No change in match rate by preferred specialty 1,130 seniors unmatched to PGY-1 positions 615 seniors with no position post-SOAP



2,400 DOs & 6,600 IMGs matched to PGY-1 positions



No change in total number of unmatched applicants in 2016



No change in percentage of applications rejected



USMLE Step scores are rising



ROLs are getting longer Reproduction prohibited without the written permission of the NRMP.

How do we help students target their applications?

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Do you agree that*…. 100 90 80 70 60 50 40 30 20 10 0 Not enough PGY-1 positions

Programs rely too much on Step 1

MSPE should follow a standard format

Programs

Applicants need more program-specific information

Applicants need programspecific information about matched applicants

Schools

*Respondents who agree or strongly agree Source: NRMP Residency Application Survey Reproduction prohibited without the written permission of the NRMP.

Share Program-Specific Information? 100 90 80 70 60 50 40 30 20 10 0 Step 1 "cut score"

Mean Step 1 score of applicants offered interviews

Mean Step 1 score of matched applicants

Programs willing to share information

Mean Step 2 score of matched applicants

Number of applicants ranked prior year

Schools would find information beneficial

Source: NRMP Residency Application Survey Reproduction prohibited without the written permission of the NRMP.

Limit Number of ERAS Applications? 100 90 80 70 60 50 40 30 20 10 0 Yes, cap

Yes, negative consequences for programs

Programs

Yes, negative consequences for students

Schools

*Respondents who agree or strongly agree Source: NRMP Residency Application Survey Reproduction prohibited without the written permission of the NRMP.

Transition to Residency: Conversations Across the Medical Education Continuum May 4-6, 2017 www.nrmpconference.org 

Anna Quindlen: Health Care in an Information Age



Dr. Daniel Goleman: Emotionally Intelligent Healthcare in Medical Education



Dr. Kenneth Shine: Sustaining the Medical Education Enterprise

Deadline for Breakout Session Proposals: November 30

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Transition to Residency: Conversations Across the Medical Education Continuum May 4-6, 2017 Broad Themes:  Goodness of Fit: exploring the role of medical schools and

residency programs in addressing application overload  Matching Process: using Match data to understand and inform

workforce planning  Unmatched Applicants: examining outcomes and considering

alternatives to clinical medicine  Innovations in Medical Education: evaluating the flexibility of the

Match in supporting competency-based curricula  Single Accreditation System

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