Results from the National Resident Matching Program (NRMP) Main Residency Match, combined with the AOA Match, the Military Match, and sub-specialty match programs, show that 98% of all 2019 graduates from the nation’s DO-granting medical schools matched into graduate medical education (GME) residency programs, according to the American Association of Colleges of Osteopathic Medicine. While final numbers are expected to be available later this spring, the overall success of DO students and residents is spectacular news for the nation’s colleges of osteopathic medicine and related stakeholders.
Despite this historic success, the way in which DO and MD medical students pursue residency training positions in the United States is under fire. And the complex multi-layered system that connects MD and DO medical students to residency programs appears to be operating at a far cry from eHarmony.
Challenges and Potential Opportunities with the Current Match System
Often people refer to the NRMP as “The Match,” but in 2019 there still exist other mechanisms by which applicants may pursue graduate medical education (GME) positions, including the AOA Match and Military Match. Starting in 2020, however, programs that formerly used the AOA Match and have achieved ACGME Accreditation will now use the NRMP Match as part of the Single Accreditation System. Residency applicants will await results from the NRMP Match that culminates on a single day with the simultaneous announcement of binding three- to five-year training/job commitments and program specialties for some 40,000 students and doctors.
Both residency programs and applicants face stressful complications from the match process as it exists today. It’s common for MD and DO applicants to apply to 50-150+ residency programs because of the perceived competition to get into a residency program and the ease of electronic applications. After candidates apply, programs extend interview invitations in September through November, sometimes requiring responses within an hour by applicants for them to avoid losing the opportunity. Students spend considerable time and money traveling to interviews, and sometimes are pressured to declare their intent to rank a specific program #1 on their list prior to the program director submitting their rank list to NRMP. To sort through an increasing number of applicants, program directors resort to COMLEX-USA and USMLE exam scores to filter through applicants, despite knowing that neither licensing exam was designed with that as its primary purpose.
The American Medical Association (AMA) and other stakeholders are demanding changes to the system. Numerous suggestions have been put forward — from traffic rules for granting interviews, to pre-signaling program preferences by applicants. In response, the AMA, the Federation of State Medical Boards (FSMB), the National Board of Medical Examiners (NBME), and others (including the NBOME), met to discuss the pros and cons of possible changes to licensure exam scoring and reporting. Conversations explored the possible elimination of numerical scores for licensing exams, allowing candidates to elect for scores on only pass-fail reporting, holding back numeric scores until after a successful match, and creating new composite scoring to include clinical skills examination data. Dialogue also continued around COMLEX-USA and USMLE equality by ACGME residency program directors — an important clarification that has been contributing to heightened stress among DO students.
The discussions and debates are likely to heat up across the house of medicine, and the NBOME, as usual, will be actively listening and participating. The argument not to continue the status quo is supported by increasing evidence of anxiety, depression and other mental health issues among MD and DO medical students, which clearly translates to a patient safety issue. As we delve deeper into this topic, we will endeavor to remain true to our mission of supporting assessment features that protect the public and patients, who are ultimately served by those who rely on our products and services, both for the primary and important secondary purposes of the assessments.
Here’s a quick recap of what happened during this year’s match programs:
The 2019 AOA Match
19% of graduating senior students and several hundred prior graduates participated in the American Osteopathic Association (AOA) residency match this year, and of those, 54% matched to a program, with more than 500 placed into primary care specialties. The top 5 specialties in the AOA Match this year included Family Medicine, with 34% of placements, followed by Internal Medicine at 22%, and Orthopedic Surgery at 12%. Many of the remaining 81% of graduating seniors went on to participate in the NRMP match the following month.
The 2019 NRMP Main Residency Match
NRMP’s Match Day saw a total of 38,367 total applicants submitting program choices for 35,185 residency slots. In 2018, there were 37,103 applicants and 33,167 slots – an increase of 1,264 and 2,018 respectively. This year, a record number of 6,001 osteopathic medical students and graduates submitted NRMP program choices, and 84.6 percent of those matched to PGY-1 positions — an all-time high. The number of osteopathic medical students participating in the NRMP match has risen by 3,052 candidates, a 103 percent increase since 2015.
The 2019 NRMP Specialty and Fellowship Match
We also saw impressive results from our osteopathic graduates in the NRMP’s specialty match this year as well. Osteopathic residents enjoyed a 78.9% match rate — a 2% increase over 2018. And a big congratulations to the 1000+ new DOs who matched to ACGME Fellowship programs, more than any year prior. The ACGME further clarified that COMLEX-USA and USMLE are both acceptable for Fellowship Programs in their updated Common Program Requirements.
Congratulations to the nation’s DO and MD students and residents who were successful in navigating the matching processes in 2019, and to the schools and residency programs for hopefully facilitating successful “matches” and transition processes as students transition to become residents, and some residents move on to fellowship training.
Contributed by John R. Gimpel, DO, MEd | President and CEO | NBOME