Lessons Learned from the 2014 NRMP Match

September 16, 2014
The Residency Program Director 2

med-Medical-Residency-Series-2014The academic year is in full swing. The interns are quickly learning the ropes and arcing the proverbial steep learning curve. It’s hard to believe that the new residency recruitment cycle is about to begin and that the ERAS mailbox has opened this week. As we prepare for the 2015 NRMP Match, it’s helpful to reflect on the 2014 match outcomes to see if there are lessons to be gleaned and predictions to be made.

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Data from the NRMP 2014 Match did not reveal a significant change from the 2013 match, and there was good news to report. The overall match rate to first year positions was 75 percent which was the highest since 2006, according to a press release by the NRMP in March, 2014. There were more IMGs and osteopathic students/graduates in the match which was not surprising given the “All-In Policy” implemented in 2012. The PGY-1 match rate for osteopathic candidates was 77.7 percent, the highest in 30 years. The percentage of U.S. IMGs who matched in 2014 rose slightly to 53%, compared with 52.8% in the 2013 match. The percentage of non-U.S. IMGs who matched was 49.5% compared with 47% the prior year. Of those matched applicants this year, 54.2% of U.S. seniors received their first rank compared with 49.8% of independent applicants. Competitive specialties like Dermatology and Radiation Oncology were filled entirely with U.S. seniors. Other details about the 2014 match data are available from the NRMP’s report on the 2014 Main Residency Match.

In January 2014, the NRMP and ECFMG released a report on the match outcomes for IMGs in the 2013 match. While a similar report is not yet available on the 2014 match, I suspect the trends will be similar. The successful IMG applicant ranked more programs, had higher USMLE Step 1 and 2 scores, had fewer attempts at these exams, were U.S. citizens, and spoke English as a native language. The mean USMLE Step 1 score for those U.S. IMGs who matched was 217 compared with 204 for those who did not match. For non U.S. IMGs the mean score for those who matched was 227 compared with 213 for those who didn’t match. The mean USMLE Step 2 scores among U.S. IMGs and non-U.S. IMGs who successfully matched were 224 and 233 respectively, and for those who did not match, the U.S. IMG and non-US IMG mean scores were 209 and 218 respectively. Overall, 48% of U.S. IMGs matched to their preferred specialty.

There is speculation that the likelihood for IMG graduates to match successfully will decrease given the projected 30% increase in U.S. medical school enrollment by 2018, and relatively stable residency spots. But it’s really not clear how all of the numbers will pan out. While the all-in-policy has resulted in more programs recruiting for candidates in the match, there are still some programs that exclusively recruit for their residency spots out of the match – spots that only IMGs and osteopathic students can interview for. It’s hard to know which programs and consequently, how many residency spots are “all-out,” at this stage of the recruitment season since programs have until January 31st to completely withdraw from the match.   Another factor to consider is that not all of the positions in the match were filled – of the 29,671 positions offered through the match in 2014, only 28,490 were filled. It should be noted that the overwhelming majority of programs have opted to go “all-in” since the inception of the policy.

For those of you early in the planning stages of a career in medicine, the above statistics lead me to make the following recommendations:

  • It’s very important to pass all the USMLE/COMLEX steps and CS on your first attempt, and you must prepare diligently to do extremely well. While step scores are not the only criteria, they continue to represent the first screening cut in deciding who to interview.
  • Research and choose your specialty wisely and develop a safety plan.
  • Obtain good advice at every step of your application to residency. Don’t try to wing it as the stakes are too high – get the proper counseling at every step toward the application process.

The bottom line is that it is not clear what shape the 2015 NRMP Match will take, but it should reveal interesting trends for the future. What I know for sure is that if you absolutely know you want a career in medicine, like everything else that you deeply want, you must plan carefully and deliberately. Leave no aspect of your medical education, planning for licensing exams, and your application to chance. Good luck to those of you about to submit your applications. Let’s take a collective deep breath and let this exciting season begin!


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