The joyful Match Day headlines and social media posts don’t align with the heartbreaking reality of too many talented residency applicants who don’t land a position. Another discrepancy lies between the commonly reported figures on residency match rates and a truer picture of how many applicants go unmatched, argues a recently published perspective in a major medical journal whose lead author is a medical student.
Nicole M. Mott, a medical student at University of Michigan Medical School who will start her general surgery residency this summer, and her co-authors wrote the article to explain their view of the flaws in the process. The article, “What’s in a Number? Breaking Down the Residency Match Rate,” was published in The New England Journal of Medicine.
“When you hear that the match rate is super high, and you don’t match, you might feel ostracized, or stigmatized or wonder what’s wrong with you,” Mott said in an interview with the AMA. “The reality is that there are a lot of unmatched applicants for a number of reasons, and in some instances no good reason at all other than the numbers.”
The match rate that is typically most publicized on Match Day is that of senior students from U.S. MD-granting medical schools, who comprise less than half of the pool of applicants aiming to obtain a residency position. About 92% to 95% of applicants from this group obtain a residency position each year through the Match.
Other applicant groups include U.S. DO seniors, who tend to match at a rate similar to that of MD seniors, previous graduates of U.S. medical schools, and international medical graduates. The latter two groups have lower match rates than U.S. seniors.
But, Mott and her co-authors explained, even within the U.S. seniors group, the numerator and denominator can be misleading. For example, there is a group of applicants that applies to residency programs but never submits a match rank-order list. It is unclear what happens to these applicants, but one hypothesis is they apply but never get interview invitations and therefore never submit a rank-order list.
This creates an underestimation of the number of doctors who are unable to obtain residency positions, wrote Mott and her co-authors, who include Maya M. Hammoud, MD, MBA , senior adviser for medical education innovations at the AMA and professor obstetrics and gynecology and learning health sciences at University of Michigan Medical School, which is a member school of the AMA Accelerating Change in Medical Education Consortium.
Match rates within specialties can also vary widely. For instance, in 2020, match rates for U.S. seniors in MD programs applying to otolaryngology (74.9%) and general surgery (83.2%) were well below the average match rate of 92.8% overall for that group of applicants.
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The current residency-selection process is congested by overapplication, Mott and her co-authors wrote. Among the potential solutions outlined in the article are additional information such as transparency requiring programs to detail their selection criteria to applicants, requiring applicants to invest additional time in a program via a secondary application, or imposing application or interview caps in specialties. Some specialties are also using a program-signaling system, and that number is expected to grow to 15 specialties with the 2022–2023 residency selection cycle.
Mott said a closer look at the numbers beyond the Match reveals there needs to be a reconsideration of the methods to the process.
“We shouldn’t allow an artificial inflation of a single statistic [the match rate] to be our marker of whether the residency-selection process is in a healthy state,” she said. “If we keep looking toward it, we will be ignoring other numbers that are going to be painting another picture—and by considering the right numbers we can look to them and tell a different story.”
“Our current residency-selection process is congested, inefficient and it takes a toll on applicants both personally and professionally,” Mott added. “That’s the story these numbers tell. We need to question is this the best way to do things, and are there areas for improvement?”
Learn about AMA policy on National Resident Matching Program reform, last modified in 2021.