Main Residency Match:Is It Becoming More Competitive?
MONA M. SIGNER
LEARN SERVE LEAD
NOVEMBER 10, 2019
Main Residency MatchActive Applicants and PGY-1 Positions
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
16,070 16,559 16,527 17,487 17,374 18,025 18,187 18,539 18,818 18,925 19,125
1,3561,364 1,317
1,487 1,6621,520 1,502 1,472 1,511 1,485 1,450
2,0452,178 2,360
2,677 2,7382,949 2,982
3,5904,617
6,001 6,500
3,6953,769 4,279
5,095 5,1335,014 5,323
5,069
5,075
5,0805,100
7,246 6,6596,828
7,568 7,3347,366
7,4607,284
7,067
6,8696,850
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
US MD Seniors Prior US Grads DOs US IMGs IMGs Others PGY-1 Positions
13,269 More PGY-1 Positions Than Active MD Seniors in 2019
Main Residency MatchPGY-1 Matches by Applicant Type
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
14,992 15,588 15,712 16,390 16,399 16,932 17,057 17,480 17,740 17,763
608599 557
607 798 662 732 677 663 674
1,4441,561 1,764
2,002 2,127 2,338 2,3962,933
3,7715,076
1,7491,884 2,100
2,691 2,7222,660 2,869
2,7772,900
2,997
2,8812,721 2,770
3,556 3,633 3,641 3,7693,814
3,962
4,028
8,795 8,2048,431
9,091 8,5838,653
8,6408,281
8,0637,826
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
US Seniors Prior US Grads DOs US IMGs IMGs Others Unmatched
Number of Unmatched Applicants Declined for 4 Consecutive Years
Main Residency MatchPGY-1 Match Rate by Applicant Type
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
93.9
45.4
84.6
5958.6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
US MD Senior Match Rate Steady at +/-94%
US MD Seniors
DO Physicians
US IMGs
IMGs
Prior US MD Grads
Main Residency MatchUS MD Seniors Matched to PGY-1 Positions
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
14,992
17,763
1,078 1,162
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Matched Unmatched
2,771 More MD Seniors Matched Since 2010
US MD Seniors in SOAP2012-2019
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
1,816
605 600
337
2,076
595 602 591
2,051
609 623
506
2,142
653 645606
2,199
665 666615
2,140
610 633570
2,146
581 609 620
1,916
663 684623
0
500
1,000
1,500
2,000
2,500
SOAP Eligible Offers Accepted Unique Applicants With Any Offers No Position Post-SOAP*
SOAP 2012 SOAP 2013 SOAP 2014 SOAP 2015 SOAP 2016 SOAP 2017 SOAP 2018 SOAP 2019
*All SOAP Eligible seniors who did not have any position at the conclusion of SOAP, regardless of whether they submitted a ROL.
US MD Seniors’ Match Rates By Preferred SpecialtyMost Match to Their First-Choice Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
75 76 77 77
83
89 8990 91 91 91
94 95 96 97 97 98 98
8481 82
8684
78
9088
84
92
9996 96 97
93
99
9397
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2016 2019
Percent Programs Citing Each Factor: Interview Selection
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
37%
41%
46%
47%
50%
52%
53%
54%
54%
56%
58%
59%
60%
61%
65%
65%
67%
68%
69%
70%
70%
76%
78%
80%
81%
86%
94%
0% 25% 50% 75% 100%
Applicant flagged with match violation by NRMP
Demonstrated involvement in research
Honors in clerkship in desired specialty
Gold Humanism Society membership
Graduate of highly regarded U.S. medical school
Honors in clinical clerkships
Gaps in medical education
Volunteer/extracurricular experiences
Consistency of grades
Passing USMLE Step 2/COMLEX Level 2 PE
Other life experience
Perceived interest in program
Alpha Omega Alpha membership
Leadership qualities
Audition elective/rotation within your department
Evidence of professionalism & ethics
Grades in clerkship in desired specialty
Personal prior knowledge of the applicant
Perceived commitment to specialty
Any failed attempt in USMLE/COMLEX
Class ranking/quartile
Grades in required clerkships
Personal Statement
USMLE/COMLEX Step 2 score
Medical Student Performance Evaluation
Letters of recommendation in the specialty
USMLE/COMLEX Step 1 score
Source: NRMP 2018 Program Director Survey
Average Percentage Applications RejectedBased on Standardized Screening Process
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
25%
26%
29%
32%
32%
33%
37%
39%
43%
43%
44%
48%
49%
49%
50%
51%
52%
53%
53%
54%
60%
61%
66%
14%
19%
34%
40%
29%
33%
42%
30%
38%
40%
47%
50%
41%
51%
48%
46%
39%
50%
53%
48%
58%
61%
61%
0% 25% 50% 75% 100%
Otolaryngology
Radiation Oncology
Dermatology
Neurological Surgery
Vascular Surgery
Plastic Surgery
Thoracic Surgery
Emergency Medicine
Radiology-Diagnostic
Internal Medicine/Pediatrics
Anesthesiology
Neurology
Physical Medicine and Rehabilitation
Orthopaedic Surgery
Average for all specialties
Pathology-Anatomic and Clinical
Child Neurology
Obstetrics and Gynecology
Pediatrics
Psychiatry
General Surgery
Internal Medicine Categorical
Family Medicine
2018 2016
Source: NRMP Program Director Survey
Percent Programs Citing Each Factor: RankingIt’s All About the Interview
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
23%
26%
30%
30%
32%
36%
36%
38%
40%
41%
44%
45%
46%
47%
51%
54%
56%
58%
58%
59%
60%
63%
64%
65%
65%
70%
72%
78%
86%
91%
95%
96%
0% 25% 50% 75% 100%
Other post-interview contactApplicant flagged with match violation by NRMP
Demonstrated involvement in researchHonors in clerkship in desired specialty
Honors in clinical clerkshipsGold Humanism Society membership
Graduate of highly regarded U.S. medical schoolGaps in medical education
Volunteer/extracurricular experiencesConsistency of grades
Alpha Omega Alpha membershipOther life experience
Grades in clerkship in desired specialtyAny failed attempt in USMLE/COMLEX
Passing USMLE Step 2/COMLEX Level 2 PEGrades in required clerkships
Personal StatementAudition elective/rotation within your department
Personal prior knowledge of the applicantClass ranking/quartile
Leadership qualitiesPerceived interest in program
Perceived commitment to specialtyEvidence of professionalism & ethics
Medical Student Performance EvaluationUSMLE/COMLEX Step 2 score
Letters of recommendation in the specialtyUSMLE/COMLEX Step 1 score
Feedback from current residentsInteractions with housestaff during interview
Interpersonal skillsInteractions with faculty during interview
Source: NRMP 2018 Program Director Survey
Program Use of USMLE Step 1 Scores
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
Consider applicants who fail 1st
attempt?
30%
59%
11%
30%
58%
12%
0%
20%
40%
60%
80%
100%
Never Seldom Often
32%
67%
1%
34%
64%
2%
0%
20%
40%
60%
80%
100%
Yes, pass only Yes, targetscore
No
Source: NRMP Program Director Survey
Exam Required for Interview?
2016 2018
Two-thirds use a target
score
88% never or seldom consider
applicants with a failure
Step 1 Scores Are Rising By Preferred Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
200
210
220
230
240
250
260
270
High Low 2007 Median 2011 Median 2015 Median 2019 MedianSource: NRMP Data Warehouse and AAMC Data Warehouse.
Program Use of USMLE Step 2CK Scores
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
Consider applicants who fail 1st
attempt?
35%
57%
8%
35%
57%
8%
0%
20%
40%
60%
80%
100%
Never Seldom Often
34%
49%
17%21%
39% 40%
0%
20%
40%
60%
80%
100%
Yes, pass only Yes, targetscore
No
Source: NRMP Program Director Survey
Exam Required for Interview?
2016 2018
Fewer programs require
Step 2 for interviews
92% never or seldom consider
applicants with a failure
Step 2 CK Scores Are RisingBy Preferred Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
200
210
220
230
240
250
260
270
High Low 2007 Median 2011 Median 2015 Median 2019 MedianSource: NRMP Data Warehouse and AAMC Data Warehouse.
Percent US MD Seniors Citing Each Factor: Applications
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
38%
41%
46%
46%
51%
52%
53%
53%
54%
56%
56%
57%
57%
58%
61%
64%
64%
67%
68%
83%
84%
88%
0% 25% 50% 75% 100%
Cultural/ethnic diversity of geographic location
Research opportunities
Program flexibility to pursue electives
Quality of hospital facility
Diversity of patient problems
Preparation for fellowship training
Housetaff morale
Social & recreational opportunities in area
Balance between supervision & patient care
Career paths of recent program graduates
Program size
Future fellowship opportunities in the institution
Quality of program director
Cost of living
Quality of faculty
Work/life balance
Quality of curriculum & training
Quality of residents in program
Academic medical center program
Reputation of program
Perceived goodness of fit
Geographic location
Source: 2019 Applicant Survey
Percent US MD Seniors Citing Each Factor: Applications (cont’d)
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
4%
5%
6%
8%
13%
15%
16%
16%
20%
21%
23%
23%
24%
27%
27%
30%
33%
33%
34%
35%
35%
36%
0% 25% 50% 75% 100%
Previous Match violation
Other benefits
Schools for my children in the area
Alternative duty hours
Opportunity for systems-based practice
Having friends at the program
Quality of ambulatory facilities
Supplemental income (moonlighting) opportunities
Opportunity for international experience
Community-based program
ABMS board pass rates
Availability of electronic medical record
Salary
Vacation/parental/sick leave
Quality of ancillary staff
Size of patient caseload
Cultural/ethnic diversity at institution
Opportunities to perform specific procedures
Call schedule
Support network in the area
Future job opportunities for myself
Job opportunities for my spouse/significant other
Source: 2019 Applicant Survey
Percent US MD Seniors Citing Each Factor: Ranking
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
35%
38%
42%
42%
43%
44%
44%
45%
47%
47%
48%
50%
55%
61%
61%
62%
64%
65%
71%
75%
77%
89%
0% 25% 50% 75% 100%
Call schedule
Research opportunities
Quality of hospital facility
Program flexibility to pursue electives
Social & recreational opportunities in area
Diversity of patient problems
Program size
Future fellowship opportunities in the institution
Balance between supervision & patient care
Cost of living
Preparation for fellowship training
Career paths of recent program graduates
Academic medical center program
Housetaff morale
Quality of curriculum & training
Work/life balance
Quality of faculty
Quality of program director
Reputation of program
Quality of residents in program
Geographic location
Perceived goodness of fit
Source: 2019 Applicant Survey
Percent US MD Seniors Citing Each Factor: Ranking (cont’d)
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
3%
4%
4%
4%
7%
11%
13%
13%
14%
17%
17%
18%
21%
23%
24%
25%
29%
30%
31%
32%
32%
33%
0% 25% 50%
Previous Match violation
Other benefits
Schools for my children in the area
Alternative duty hours
Opportunity for systems-based practice
Having friends at the program
Supplemental income (moonlighting) opportunities
Community-based program
Quality of ambulatory facilities
Opportunity for international experience
Availability of electronic medical record
ABMS board pass rates
Vacation/parental/sick leave
Salary
Opportunities to perform specific procedures
Quality of ancillary staff
Size of patient caseload
Cultural/ethnic diversity at institution
Cultural/ethnic diversity of geographic location
Support network in the area
Future job opportunities for myself
Job opportunities for my spouse/significant other
Source: 2019 Applicant Survey
Matched Applicants*Applications, Interviews, Programs Ranked in Preferred Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
115.3
126.6
55.1
57.9
45.2
7.7
9.3
11.1
7.8
12.9
7.5
9.2
10.9
7.4
12.9
0 20 40 60 80 100 120 140
Foreign
US Foreign
Osteopathic
US MDGraduate
US MD Senior
Applications
Programs Ranked
Interviews Attended
*Applicants matched to preferred or alternate specialtySource: NRMP 2019 Applicant Survey
Fewest applications;
highest ratio of interviews
& ranked programs
Matched Applicants*Applications, Interviews, Programs Ranked in Alternate Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
69.3
84.8
32.8
45.6
28.1
3.3
4.6
5
5.3
6.6
3.3
4.4
4.6
4.9
6.1
0 20 40 60 80 100 120 140
Foreign
US Foreign
Osteopathic
US MDGraduate
US MD Senior
Applications
Programs Ranked
Interviews Attended
*Applicants matched to preferred or alternate specialty
Source: NRMP 2019 Applicant Survey
Fewest applications;
highest ratio of interviews
& ranked programs
Unmatched ApplicantsApplications, Interviews, Programs Ranked in Preferred Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
95.5
94.5
64.5
64.8
65.6
2.6
2.7
5.2
3.6
7.8
2.6
3.2
5.2
4.3
7.8
-10 10 30 50 70 90 110 130 150
Foreign
US Foreign
Osteopathic
US MD Graduate
US MD Senior
Applications
Programs Ranked
Interviews Attended
Source: NRMP 2019 Applicant Survey
Highest ratio of
interviews &
ranked programs to
applications
Unmatched ApplicantsApplications, Interviews, Programs Ranked in Alternate Specialty
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
65.1
70.3
27.8
31.5
44.4
1.5
1.5
2.3
1.2
4.2
1.6
1.9
2.3
1.2
3.8
0 20 40 60 80 100
Foreign
US Foreign
Osteopathic
US MDGraduate
US MD Senior
Applications
Programs Ranked
Interviews Attended
Source: NRMP 2019 Applicant Survey
Did not rank all
programs where they
interviewed
US MD Seniors Matched and UnmatchedApplications, Interviews, Programs Ranked
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
44.4
65.6
37.8
45.2
4.2
7.8
8.6
12.9
3.8
7.8
8.3
12.9
0 20 40 60 80 100 120 140
Unmatched(applications,
interviews,programs ranked inalternate specialty)
Unmatched(applications,
interviews,programs ranked inpreferred specialty)
Matched toAlternate Specialty
(applications,interviews,
programs ranked inalternate specialty)
Matched toPreferred Specialty
(applications,interviews,
programs ranked infirst-choicespecialty)
Applications
Programs Ranked
Interviews Attended
Source: NRMP 2019 Applicant Survey
+20.4 applications in
preferred specialty;
5 fewer interviews
+6.6 applications in
alternate specialty;
4.4 fewer interviews
Unmatched US MD SeniorsLower Yield Per Application, Fewer Interviews, Fewer Programs Ranked
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
11.6
12.0
15.3
110.0
19.0
19.5
26.6
73.3
0 20 40 60 80 100 120 140
Programs Ranked
Interviews Attended
Interviews Granted
Applications for Preferred + Alternate Specialty
Average Number of
Matched Unmatched
36.7 more
applications
11.3 fewer interview offers
7.5 fewer interviews attended
7.4 fewer ranked programs
Source: NRMP 2019 Applicant Survey
US MD Seniors’ Ranking Behavior
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
3%
10%
13%
22%
52%
65%
75%
1%
4%
22%
45%
74%
68%
88%
0% 20% 40% 60% 80% 100%
Ranked one or more programs where I applied but did notinterview
Ranked programs based on the likelihood of matching
Ranked a mix of competitive and less competitivespecialties as a "fallback plan"
Ranked one or more less competitive programs inpreferred specialty as a "safety net"
Ranked all programs I was willing to attend
Ranked all programs at which I interviewed
Ranked the programs in order of my preferences
Matched Unmatched
Less likely to rank
programs in order of
preference
Less likely to rank all
programs where they
interviewed
Less likely to rank all
programs willing to attend
Less likely to rank a “safety net”
program in preferred specialty
Less likely to have a “fallback
plan” in alternate specialties
More likely to rank based on
likelihood of matching
More likely to rank programs
where they did not interview
Source: NRMP 2019 Applicant Survey
Unmatched US MD Seniors by SchoolFive-Year Average: 2015-2019
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
0
5
10
15
20
0% 5% 10% 15% 20% 25% 30%
Nu
mb
er
Un
ma
tch
ed
Percent Unmatched
Average = 7.3 graduates/school
Average = 5.7% of class
Is the Match Becoming More Competitive?
FAIR, EFFICIENT, TRANSPARENT, AND RELIABLE
13,269 more PGY-1 positions than active US MD seniors• Even so, 623 MD seniors had no position post-SOAP
• BUT, 5,076 DOs, 2,997 USIMGs, and 4,028 IMGs matched to PYG-1 positions
• Total number of unmatched applicants declined for 4 consecutive years
US MD senior PGY-1 match rate steady at +/- 94%• Little change in US MD senior match rates by preferred specialty
• Match rates for other applicants steady or rising
Step 1 and Step 2CK scores are rising
• Two-thirds of programs never/seldom consider applicants with a Step 1 failure
• 88% of programs never/seldom consider applicants with a Step 2CK failure
• Fewer programs require Step 2CK for interview
Little change in percentage of applications rejected without review
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