The AfterMatch

25 03 2013

The AfterMatch

If you know anyone in medical education, you know that Match Day occurred last Friday.  I wrote a post about Match Day last year that goes into more detail about the actual process of the NRMP Match, so I won’t insult your memories by describing it again.  If you are a newer follower of this blog, feel free to go back and read that post before continuing.

This year’s Match was particularly fun and exciting for me for 2 reasons.  First, I was genuinely excited for my matriculating classmates to discover where they would be continuing their medical training for the next 3-7 years.  Second, I will be matching next year, and it was really great to experience the excitement and energy of the day without the nausea and self-doubt that comes with going through the process yourself.  (If you forgot, I am taking an extra year for a graduate degree and will be matching next year rather than this year). 

It was as much fun as I had expected, and the vast majority of my classmates matched into their first-choice programs.  There were a handful of disappointments, as there generally are, but nothing major that I know of.  On that day, I felt so optimistic and energized for my own Match Day.

Then I started hearing disturbing things from the faculty involved in our area’s residency programs.  As it turned out, an astounding 1,100 US medical seniors did not match at all. They will all be graduating in a couple of months without jobs, unable to get a job in the medical field, and with about $200k in student loans that go into repayment next January.  The number last year was much lower, I’ve heard figures ranging from 100 to 850, but the jump was shocking for the faculty I spoke with.

Every year, students don’t match for a variety of reasons, and as bad as that number is, there were two numbers that scared me even more: 10 and 17.  Those were the numbers of positions in the country that each that pediatrics and internal medicine residency programs, respectively, had available to students at the time the SOAP (formerly known as the ‘scramble’) began. 

Let me explain why those numbers are frightening.  Typically, when medical students don’t match into a residency program in the General Match (and are subsequently forced to participate in the SOAP), it is because they are either poor students overall, or they are average/good students applying to programs that are out of their league.  This is typically seen in specialties like dermatology, ENT, plastic surgery, and orthopedic surgery.  It can also happen with the primary care specialties—which are considered to be less competitive—when the student only applies to programs like Harvard, Yale, and Boston University.  Having a fewer number of spots available at the SOAP for all pediatric programs indicates that there are other reasons, potentially more serious ones, for the 1,100 unmatched US graduates this year.

The most concerning issue to me is a political one.  Shocking, I know.  As much as I like President Obama, he’s made some pretty boneheaded decisions where medical education is concerned.  The ACA calls for a greater number of physicians in primary care practice, and so in the last 3-5 years, the government has authorized both the creation of new medical schools and expansion of class sizes at the existing ones.  At the same time, GME funding is on the chopping block and Medicare/Medicaid payments are being reduced even further.  Because this is how residency programs are funded, the numbers of slots in the training programs is dwindling.  One residency program in my general area went belly-up a couple of years ago.  Add that to the 80 hour workweek cap for residents, and working crazy hours for about the same wage as the cashier at Speedway isn’t enough of a bargain for hospitals anymore.  In this economy, hospital administrators are not likely to continue making choices that are not fiscally sound.

As medical students, we are told over and over again that there is a residency position available for every senior medical student.  Even though the NRMP’s website boasts more new residency positions than ever this year, US medical grads are falling through the cracks.  Why?  This country’s residency programs also accept international medical graduates to train with them, and even though they are supposed to give preference to the US grads, this may not be happening.  I can understand why program directors would want to do this.  In an increasingly litigious environment where the workweek is capped, I can see accepting a high-performing IMG (generally, these graduates are certified physicians in their own countries, often bringing years of experience to the table) over a low-performing, brand-spankin’-new US graduate.   

I came across an editorial piece on the web this past weekend that addresses many of the same issues (you can see it here: http://thehealthcareblog.com/blog/2013/03/18/health-care-by-the-numbers-what-the-early-2013-match-day-numbers-tell-us-about-where-were-going/). 

My eyes and ears are alert for news about why this happened to so many US medical graduates.  1,100 students will graduate this May/June with medical degrees and will not be qualified to do a single job in the healthcare field (except, perhaps, work for big pharma).  They will have no choice but to go into loan repayment early next year on an enormous sum of money without adequate sources of income.  And they will all be entering the Match with me next year along with graduating classes from newly established medical schools. 

Bottom line: this was a pretty painful reminder of the potential consequences if I do not manage to keep my nose to the grindstone in the next year.  So I will keep doing the best I can, cross my fingers, and hope for the best

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