WASHINGTON -- As medical students all around the country opened envelopes on Friday containing their future for the next several years, they were part of the biggest residency Match Day in history.
A total of 37,103 applicants applied for 33,167 positions, the most ever offered in the match, according to the National Resident Matching Program (NRMP), the organization that coordinates Match Day. Of the available positions, 96.2% were filled, up 0.2% from last year. The number of available first-year positions rose to 30,232, an increase of 1,383 over 2017, the NRMP noted in a press release.
In terms of specialties, the big winners this year were Integrated Interventional Radiology, Neurological Surgery, Physical Medicine and Rehabilitation, and Thoracic Surgery, which all filled every one of their available positions. The losers? Mostly preliminary 1-year residency programs, including Ob/gyn (52.4% of slots filled), Surgery (65.2%), and pediatrics (73.7%). Medicine-Dermatology, which was not a 1-year program, filled 83.3% of its slots. Of the low-filling specialties, the 1-year Surgery programs dwarfed all the others in size, at 1,363 slots offered, while the other programs had 21 or fewer positions available.
Although primary care residencies filled well overall -- at 96.7% for Family Medicine and 97.6% for Internal Medicine -- "they're not filling with as many U.S. allopathic medical school seniors as more competitive specialties, often the surgical specialties," which is consistent with previous years, Mona Signer, the NRMP's president and CEO, told 鶹ý in a phone interview. "It probably has at least something to do with compensation; surgical specialties pay much more than primary care specialties."
The larger residencies that were most popular with U.S. allopathic medical school graduates included Orthopedic Surgery, with 93.1% of its 742 slots filled by U.S. seniors; Integrated Plastic Surgery (92.9% of 168 slots); and Otolaryngology (90.2% of 315 slots). Faring worst among U.S. allopathic graduates were Family Medicine; Internal Medicine; Surgery - Preliminary; Pediatrics-Primary; and Pathology, which all filled less than 45% of positions with U.S. seniors. Of that group, Family Medicine did the best, at 44.9%, while Pathology fared the worst, at 36.6%, according to the NRMP.
The NRMP also has seen a decline for the second year in a row in the number of non-U.S. citizen international medical graduates participating in the match, noted Signer. "I can't say for sure that it's due to immigration restrictions discussed by the [Trump] administration, but it seems likely that's the case," she said. "We're just not creating a hospitable environment."
Darrell Kirch, MD, president and CEO of the Association of American Medical Colleges (AAMC), echoed that worry. "We ... remain concerned that uncertainty surrounding Deferred Action for Childhood Arrivals (DACA) and physician immigration introduced new challenges into this year's residency application process, as evidenced by a 22.7% drop in applicants from countries named in the three immigration executive actions last year," he .
"We urge the administration and Congress to increase federal support for the physician pipeline, support a permanent legislative solution for Dreamers, and ensure academic medicine's ability to meet the increasing healthcare needs of a growing, aging population."
And as medical students celebrate Match Day, the nation still faces a shortage of up to 104,900 doctors by 2030, Kirch said. "As a result, the AAMC ... has endorsed legislation to provide a modest increase in the number of federally supported residency positions, which was frozen by Congress in 1997." That bill, the , was introduced last year by Rep. Joseph Crowley (D-N.Y.) and Sen. Bill Nelson (D-Fla.). It has 77 House cosponsors and six Senate cosponsors.
The NRMP's Match Day is not the only such day taking place in the U.S. each year, although that will soon be changing. On Feb. 5th, more than 1,600 osteopathic medical school seniors and graduates , with nearly 1,000 going into primary care residency programs, according to the American Osteopathic Association (AOA). But in another few years, the osteopathic medical graduates will join a unified NRMP, in which all participants "will have the opportunity to choose programs that received osteopathic recognition, whereas previously physicians with the MD degree could not obtain osteopathic training," the AOA noted in an email.