Photo Credit: Drazen Zigic

Match Day is a highly anticipated event where graduating medical students find out where they will complete their residency training. How did 2024 measure up?

Match Day is a highly anticipated event where graduating medical students find out where they will complete their residency training. The Match is facilitated through the National Residency Matching Program (NRMP), which facilitates these matches and acts as a centralized clearing house to help medical students and residency programs find the right fit that meets their needs. While the system is not perfect, its pretty darn good, and after 72 years, NRMP has dialed in the process well. The Main Residency Match typically has 47,000 applicants and 39,000 residency positions, and the fellowship matches for more than 70 subspecialties are offered through its Specialties Matching Service.

Match Day typically occurs in March, and students across the United States gather with friends, family, and faculty to nearly simultaneously open the envelopes that contain their residency placements. Match Day marks the culmination of years of hard work and preparation for medical students. Like many rites of passage on the long road to becoming a physician, we all have memories and stories of Match Day.

I did not match right away at the end of medical school. Instead, I took some time to train and race as a professional triathlete, so I felt like I was missing out when my classmates opened their match envelopes and found out where they would spend the next few years of their training. It is a bittersweet memory, and I didnt feel celebratory. A few years later, when I entered the match, I was on call in the resident workroom, where I learned where I would be continuing the rest of my medical training. That, too, felt anticlimactic.

Some have memories of the devastation of not being matched into their top choice program or matched at all. Some remember a week of panic going through the Supplemental Offer and Acceptance Program (SOAP), formerly known as the scramble process, and even then, feeling like they were failures. We have these important memories of when and where we were and memories of mostly joy or heartache. However, I think most physicians look back on match day with fondness and perspective, knowing it was an important step in their careers. At the time, it may feel like the best or the worst day of our professional lives, but with time and perspective, I truly believe we all end up where we need to be.

There were 50,413 applicants, of which 44,853 were certified in a rank list for 41,503 certified residency positions in 6,395 residency training programs. This represented an increase of about 2% in total residency positions compared with 2023. This is a record of total applicants and certified rank lists by about 4.5%, primarily driven by an increase in non-US citizen international medical graduates (IMGs) and osteopathic (DO) seniors. US-based DO and MD applicants achieved a 92.3 and 93.5 percent match rate, respectively, which has remained stable for the past four decades. US citizen IMGs and non-US citizen IMGs achieved a 67.0 and 58.5 percent match rate, respectively, about half to a full percent lower than in past years.

Another notable trend was a rebound in Emergency Medicine (EM) match rate to 95.5% after two years of match rates far below the historical average, likely primarily driven by the COVID-19 pandemic. This EM match was an increase of 13.9%. OB/GYN achieved a 99.6 percent fill rate. Two years after the Dobbs v. Jackson Supreme Court decision, there remains strong and continued interest in providing obstetrical care. Further court decisions are expected this summer, and more potential changes are on the horizon for the specialty. However, this has not deterred medical students. Specialties with the highest percentage of US MD and DO seniors were Internal Medicine/Emergency Medicine (96.8%), Thoracic Surgery (95.8%), Otolaryngology (95.8%), Internal Medicine/Pediatrics (94.6%), Orthopedic Surgery (92.1%), Interventional Radiology-Integrated (91.4%), and Obstetrics and Gynecology (90.7%).

A point that needs to be pulled out is the fluctuations in primary care. There is an existing shortage of primary care physicians in the US, and the shortfalls are expected to widen to more than 52,000 primary care physicians by 2025, with more significant shortages in rural communities. This year, the Match offered the largest primary care residency positions at 19,423, which accounted for 46.8 percent of total match positions. Although the fill rates for Family Medicine, Internal Medicine, Internal Medicine-Pediatrics, and Pediatrics were 92.9 percent, this decreased by 1.4%. The primary care fill rate fell mainly due to changes in Pediatrics, with more residency positions offered to fewer applicants. In addition, according to the American College of Physicians, most Internal Medicine residents go on to a subspecialty fellowship, and only between 20% and 25% practice primary care. As a result, the number of those matching into primary care is likely falsely elevated, and many believe that we are not preparing the primary care and preventative physician workforce that our nation and communities require.

A total of 2,575 positions were not filled initially and placed in SOAP, including positions in programs that did not participate in the algorithm phase of the process. This was a decrease of 3.1 percent. We do not yet have data on how many positions were filled; however, historically, very few residency positions were left unfilled after SOAP.

The Match data is interesting to slice, dice, and ponder. Still, it leads me to think about more significant questions regarding how we expose medical students to different medical specialties, which may or may not impact their desire to enter a specific field of medicine. Furthermore, are we training the physician workforce we need for our communities today and tomorrow? What factors are involved, and are there minor or wide-sweeping changes we must implement in the medical school and residency process?

There has been a 33% increase in US medical school positions since 2020, and new medical schools opening across the US bring the promise to supply physicians to communities in need. Positions in medical schools are great, but they do not create doctors in those communities. Compounding the problem, the increase in residency positions has not kept pace with the increasing number of medical school graduates. According to the American Association of Medical Colleges, 54.2%of the individuals who completed residency training from 2008 through 2017 are practicing in the state where they completed residency, with 56% practicing within 100 miles of their residency location. Resident retention rates range from 27.2% in Wyoming to 77.7% in California. Suppose we want to ensure that rural and underserved communities have an adequate physician workforce. In that case, we need to create policies and systems that will enable and support the certation residency programs in those geographic areas with the highest need and with the right mix of specialties.

Graduate Medical Education (GME), also known as a residency, is a decentralized system that favors hospital and health system needs and individual medical student choice, which is vital to maintaining professional wellness and a long and rewarding career in medicine. However, multiple policies incentivize residency type and the culture of medical school and systems that emphasize positive or damaging exposure to different medical specialties, which may influence medical student choice.

Perhaps, the biggest policy that needs to be considered, or reconsidered, is Medicares GME funding formula, which has undergone little revision since its inception in 1965. Medicare is the largest funding source for graduate medical education, accounting for $16.2 billion in 2020. GME funding is complicated, and there is a patchwork of programs and systems with various incentives. The total number of residency positions funded through Medicare is capped, and GME-funded resident locations and specialties are unevenly distributed and heavily favor the northeast and specialty practice. Rural and underserved communities have fewer residents and Medicare GME-funded programs than urban and suburban communities. Additionally, Medicare GME funding skews heavily towards hospitals and subspecialty care. Medicare has historically played a minor role or has not funded residencies for childrens hospitals, psychiatry, and primary care, where there is the greatest need.

Overall, medical education is a continually evolving field, and stakeholders in healthcare, including medical schools, residency programs, policymakers, and healthcare organizations, must collaborate to ensure that doctors training aligns with our communities evolving needs.

Congratulations to all the medical students and residency programs who recently participated in The Match, and welcome to the next stage of your career! Regardless of whether this process yielded your dreams come true or left you feeling like your match was less than ideal, please remember that life has a funny way of helping you be just where you need to be, and your attitude and how you take advantage of what events and opportunities is perhaps most important.

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Reflections on Match Day 2024 - Physician's Weekly