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. 

Medical Student Calls for Greater Transparency in Residency Match Data

National Match Day took place on Friday, March 18, 2022. According to the National Resident Matching Program, NRMP, it was a successful day, which “realized many significant milestones” including: 

• Consistent or increased match rates across applicant types: 

--US MD Seniors PGY-1 matched at 92.9 percent (+0.1 percentage points from 2021)

--US DO Seniors matched at 91.3 percent (+2.2)

--US citizen international medical graduates matched at 61.4 percent (+1.9)

--Non-US citizen international medical graduates matched at 58.1 percent (+3.3)

--And it was the highest match rate on record for previous year graduates, with US MD graduates matching at a rate of 50.5 percent (+2.3), and DO graduates matching at a rate of 53.6 percent (+9.3).

However, a recent article written by Nicole Mott, a student at the University of Michigan Medical School, and published in the New England Journal of Medicine, with a follow-up interview on MedPage Today contends that most current match reporting only tells part of the story. Mott is calling for the NRMP to reconsider how the match rate is calculated and to provide additional transparency into the match data. 

She starts by pointing out aspects of the current reporting that can be misleading or confusing. 

• The published NRMP “match rate” doesn’t include all specialties and programs; it excludes ophthalmology, urology, and military training programs. 

• The variation in match rates by applicant type should always be called out explicitly (as seen above) in recognition of the significant variation in match rates between applicant types: MD Senior, DO Senior, IMG (citizen or non-citizen), and graduates (MD, DO). The media often just reports one overall (or applicant type) match rate, which can be misleading and create inaccurate expectations among applicants regarding the likelihood of receiving a match. 

Next, she calls for a reconsideration of how the current match rate is calculated. Currently, the match rate is the proportion of “active applicants” who match into a participating residency program. However, an “active applicant” is someone who registers for the NRMP match and submits a rank order list. Mott points out that approximately eight percent of NRMP registrants withdraw or do not submit a rank order list and are thus excluded from the calculation. This includes participants who apply to programs but are not invited to interview and therefore do not submit a rank order list. This definition of active applicant likely inflates the match rate and underestimates the number of physicians who are unable to find a residency placement. 

She also provides suggestions for data that, if made publicly available, would help inform medical students as they make plans for the future.

• The number of applicants who register for NRMP match and don’t submit a rank order list, as well as the characteristics of this group. This would provide insight into potential inequities in the process, as well as applicant competitiveness for specialties. 

• The number and characteristics of unmatched physicians including those who only match into a preliminary first-year position. It would also be helpful to include information on the careers these physicians pursue and where they ended up, which could inform physician workforce planning. 

• Detailed match outcomes relevant to students going through the process, which could inform students pursuing a match, and also drive systemic improvements. This may include the specialty-specific matching positions on rank order lists, which could also inform decisions such as application or interview caps. 

Mott notes that the proportion of MD and DO seniors matched to their top-ranked programs has “subtly declined” over the past 15 years and, during the same period, the number matched to their fourth-ranked choice or lower has increased. Additionally, she calls out the “over-congestion” in the residency application process. Applicants are now applying to more programs than ever, just as programs are receiving more applicants. She recommends a review of the data to determine if caps should be placed on the number of applications and interviews. Similarly, she calls for more transparency from residency programs in their selection criteria. Programs should be explicit in the criteria they seek in an applicant, and applicants should be more specific about their goals and geographic preferences. 

Ultimately, better data, and more visibility into the match process will benefit students and residency programs, and allow each to make the best possible decisions.