Some Students Don’t Match on Residency Match Day. Do they Need More Support?

Match rates improved across all applicant types in the 2023 National Match. U.S. MD seniors garnered a 93.7 percent match rate (+0.8 percentage points from 2022) and U.S. DOs achieved an all-time high with a match rate of 91.6 percent (+0.3 percentage points from 2022). Among international medical graduates, who historically match at lower rates, U.S. citizens achieved a record high match rate of 67.6 percent (+6.2 percentage points from 2022) and non-U.S. citizens matched at a rate of 59.4 percent (+1.3 from 2022).

The Match generally brought positive feedback for the improving rates, but what about those who don’t match? “After the match, of course, there's an uptick [in calls] every year," said Pamela Wible, MD and Founder/Operator of a mental health helpline for doctors and medical students. "Matchless medical students reach out to me who don't know what to do with their lives, sitting on $300,000 of student loans, sobbing on their couch" continued Dr. Wible, in a MedPage article published after the 2021 Match.

A recent MedScape op-ed considers the challenges for matchless medical students and urges the medical community to provide more proactive and structured advice and guidance on how to navigate not matching to a position. The authors suggest the following ways that medical schools or national medical organizations can offer more meaningful support: 

• Prior to Match Day, organizations can facilitate webinars/meetings that both normalize not matching to a position and also provide guidance on useful actions. The meeting might include topics such as how to adjust career plans, approach loan repayment, enter the SOAP process, explore alternative positions in research or other fields, and reapply to a future Match process. 

• Medical schools should focus on providing mental health support services and ensuring that students know how to access these resources both prior to, on, and after Match Day. In addition to providing access to emergency counseling services, the authors suggest that schools offer stress reduction workshops/tips and opt-out mental health services prior to the Match.

• Finally, schools and the medical community must work together to destigmatize not matching. Students should feel comfortable and safe pursuing next steps knowing that their school and the wider medical community will support them as they determine how they will continue to pursue their dream of practicing medicine. 

“Stay in touch with your dean and others at your medical school and ask them for help…Also, get involved in a research project. Look for mentors at your medical school who are working in the field of medicine you want to work in and volunteer to help,” said Margarita Loeza, MD, MPH and Assistant Dean of Student Affairs and Admissions at the Charles R. Drew University of Medicine and Science in AMA article published last month. 

555 Vacant Emergency Medicine Resident Positions Remain Following National Match Day

According to social media reports, this year's National Resident Matching Program left 555 unfilled positions in emergency medicine. While the positions will likely be filled in the Supplemental Offer and Acceptance Program, it is noteworthy because, as recently as three to four years ago, the specialty was among the most competitive. This year’s number of vacancies more than doubled last year’s 219 unfilled positions, but in 2021 just 14 vacancies remained post-match. 

Several emergency medicine groups published a joint statement reacting to the open positions on the American College of Emergency Physicians website. In the statement, they noted that a combination of many factors likely influenced this year’s outcome. “Many have speculated about factors such as workforce projections, increased clinical demands, emergency department (ED) boarding, economic challenges, the impact of the COVID-19 pandemic, and the corporatization of medicine, among many others.”  

An interview between Medscape and Robert McNamara, MD, Chair of Emergency Medicine at Temple University and Chief Medical Officer of the American Academy of Emergency Medicine, provided additional insight into two of the factors: workforce projections and the corporatization of emergency medicine. In December 2021, the Annals of Emergency Medicine published a study projecting an oversupply of emergency physicians by 2030. In McNamara’s view, the suggestion of an oversupply may have deterred prospective entrants into the field who worry about finding a job and repaying loans. 

"Emergency medicine residents always have among the highest debt of any specialty," McNamara said. "They have a strong sense of social justice and often don't come from privileged backgrounds ... so they're likely to accumulate debt."

He also added that emergency medicine positions tend to fall under corporate entities more often than physician-run groups. The corporate focus on profit can lead to burnout and a lack of “physician autonomy.” 

Moving forward, the joint statement announced the creation of a Match Task Force with heavy emergency medicine representation to further understand the reasoning behind the unfilled positions and create mitigation strategies for the future.