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
Reproduction prohibited without the written permission of the NRMP.
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?
Reproduction prohibited without the written permission of the NRMP.
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
Reproduction prohibited without the written permission of the NRMP.
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
Reproduction prohibited without the written permission of the NRMP.
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