Results of the 2001 Match: A Shot Across the Bow? Joseph B. Cofer, MD, FACS Professor of Surgery Program Director University of Tennessee College of Medicine Chattanooga Unit Department of Surgery Chattanooga, Tennessee
Results of the 2001 Match: A Shot Across the Bow?
Joseph B. Cofer, MD, FACSProfessor of Surgery
Program Director
University of Tennessee College of MedicineChattanooga Unit Department of Surgery
Chattanooga, Tennessee
• Applications to the nation’s medical schools fell 3.7% in 2000 in the fourth straight year of decline
• The decline was 6% in 1999
• The applicant / acceptance ratio has dropped from 2.7 in 1995 to 2.1 in 2000
Barzansky, JAMA, 286:9,2001
Women constituted 43% of U.S. graduates in 2001 (up from 42.6% in 2000) and 46% of total first year enrollment (up from 45.8% in 2000)
Barzansky, JAMA, 286:9, 2001
Nursing Vacancy Rate
University of Cincinnati Hospital > 20%
Erlanger Hospital, Chattanooga, TN 8.6%
Estimated National Rate 11-20%
Fischer, Bulletin, ACOS, 86:8, 2001
Personal Communication
The average age of a registered nurse in the U.S. in March 2000 was 45.6 years.
Associated Press, Sept. 9, 2001
“If current trends continue, the nation will face a shortage of half a million nurses by 2020. The nursing shortage in our country is increasing, and it places our system of medical care at risk.”
Secretary Tommy Thompson, Health and Human Services, Sept. 28 , 2001
• Decreasing medical school applications• Changing demography of applicants• Nursing shortage• Shortage of ancillary personnel• Early retirement of physicians• Surgeons refusing to take call• Diverse societal issues
Fischer, Bulletin, ACOS, 86:2001
“There is a freight train headed down the track and it’s pointed directly at the fragments of what previously was a good to excellent medical system”
Fischer, Bulletin, ACOS, 86:2001
Conclusions
The environment has changed!
– Worsening nursing shortage
– Decreasing medical school applicant pool
– Increasing relative numbers of female medical students
– Societal issues
U.S. Seniors Matched to PGY-1 General Surgery
891
928915
890 883
853840
874
820
760780800820840860880900920940
1993 1994 1995 1996 1997 1998 1999 2000 2001
PGY-1 General Surgery
57
4539
31 35
55 55
73
92
0102030405060708090
100
1993 1994 1995 1996 1997 1998 1999 2000 2001
PGY-1 General Surgery
Foreign Trained Physicians Matched to PGY-1 General Surgery
Number of Programs Ranked by U.S. Senior Students to Obtain a Categorical PGY-1 Position in the Match (Total Applicants Including FMG’s)
1996 1997 1998 1999 2000 2001
11.2 10.9 9.6 9.6 9.1 8.2
(13.8) (13.5) (11.7) (11.7) (11.0) (9.9)
Match Results for U.S. Seniors Who Choose One Type of Specialty (General Surgery)
Students Matched
Students Unmatched
Ttl Students -GenSurgery Only
% BySpecialty
% Unmatched
2001 1063 50 1113 9.0 4.5
2000 1125 89 1214 9.7 7.3
1999 1120 97 1217 9.4 8.0
1998 1109 88 1197 9.3 7.4
1997 1156 202 1358 10.5 14.9
1996 1185 272 1457 11.2 18.7
1995 1209 258 1467 10.3 21.3
Ratio of U.S. Applicants Choosing a Specialty with the Number of Categorical Positions Available in that Specialty – 2001 Match
0.1Radiology – Diagnostic1.8Family Practice
Psychiatry
Internal Medicine
General Surgery
Preventive Med /Public Health
Neurology
Pathology
1.5
1.5
1.5
1.7
2.0
2.0
0.8Orthopaedic Surgery
0.6Physical Medicine
0.5Anesthesiology
0.5Plastic Surgery
0.1Radiation – Oncology
0.1Dermatology
Positions Ranked and Filled in 2001 by U.S. Senior Students
No. Ranks /Position
No. Ranks / Position
8.2
10.4
10.6
11.2
11.8
13.3
Internal Medicine
Anesthesia
Psychiatry
Family Practice
Pathology
Neurosurgery
4.7General Surgery
4.6Plastic Surgery
3.8Orthopaedic Surgery
3.2Radiation – Oncology
2.2Dermatology
0.8Radiology – Diagnostic
Old vs. New Study• Original study (1996 – 1999)
– 90 programs (1,312 residents)Am J Surg
181(44);2001
• New study (1996 – 2001)– 49 programs (of original 90)– 17 programs (new additions)
66 total programs (1,556 residents)
Total Residents in Study(% of Residents Matched That Year)
1996 1997 1998 1999 2000 2001
Old Study
305
(30.4)
323
(32.0)
337
(32.9)
347
(34.3)— —
New Study
251
(25.0)
252
(25.0)
253
(24.7)
262
(26.0)
266
(26.0)
272
(28.0)
230
YEAR
1999199819971996
Mea
n P
art
1 sc
ore
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Programs In Original Sample Providing 6 Years of Data
Programs From Original SampleNot Providing 6 Years of Data
YEAR1999199819971996
Mea
n P
art
1 sc
ore
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Programs Providing Data After the Original Study Was Published
YEAR
200120001999199819971996
Mea
n P
art
1 sc
ore
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Conclusions• Small programs that were exhibiting a
downward trend in Part I scores, and contributed data to the first study, did not contribute to the second study
• Small programs that were exhibiting an upward trend in Part I scores and who had not contributed data to the first study, added their 6 years of data to the second study
• Was this a Hiesenberg effect?
YEAR
200120001999199819971996
Mea
n
20
18
16
14
12
10
PROGSIZE
4 or fewer residents
5 or more residents
Means of Square Root of Total Number of Surgical Applicants From U.S. Medical Schools
YEAR
200120001999199819971996
Mea
n26
24
22
20
18
16
14
PROGSIZE
4 or fewer residents
5 or more residents
Means of Square Root of Total Number of Applicants to U.S. Surgery Programs
(U.S. + Foreign)
YEAR
200120001999199819971996
Mea
n
3.0
2.9
2.8
2.7
2.6
2.5
2.4
2.3
2.2
2.12.0
PROGSIZE
4 or fewer residents
5 or more residents
Analysis of Square Root of the Ratio of Applicants to Interviews Granted
YEAR
200120001999199819971996
Mea
n P
art
I Sc
ore
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Mean Part I Scores of All Residents
YEAR
200120001999199819971996
Mea
n p
art
1 sc
ore
240
235
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Mean of Part I Scores of First Resident Matched
YEAR
200120001999199819971996
Mea
n P
art
I Sc
ore
240
235
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Means of Part I Scoresof Last Resident Matched
Private
282725
1,007
216222
0 – 4> 5
University
213212
2120 – 4
Hybrid
42263
223> 5
2212130 – 4
No. of Residents
Mean Part I Board Scores
No. of Categorical PGY-1 Spots
No. of Residents
131210987654321
Ad
just
ed M
ean
Par
t I
Scor
e240
230
220
210
200
Mean Part I Score vs. Program Size Adjusted for Differences Between Years
YEAR
200120001999199819971996
Per
cent
age
AO
A.5
.4
.3
.2
.1
0.0
Percentage of All Matched Categorical Residents Who Are AOA
YEAR
200120001999199819971996
Per
cent
age
AO
A
.5
.4
.3
.2
.1
0.0
PROGSIZE
4 or fewer residents
5 or more residents
Percentage of All Matched Categorical Residents Who Are AOA by Program Size
YEAR
200120001999199819971996
Per
cent
age
.5
.4
.3
.2
.1
0.0
Percentage of First Matched Residents Who Are AOA
YEAR
200120001999199819971996
Per
cent
age
.50
.40
.30
.20
.10
0.00
Percentage of Last Matched Residents Who Are AOA
YEAR
200120001999199819971996
Med
ian
ran
k20
15
10
5
0
Median Rank List Position of All Residents Matched (p= .000)
YEAR
200120001999199819971996
Med
ran
k li
st p
osit
ion
30
25
20
15
10
5
0
PROGSIZE
4 or fewer residents
5 or more residents
Median Rank List Position of Matched Residents by Program Size
YEAR
200120001999199819971996
Med
ian
ran
k5.0
4.0
3.0
2.0
1.0
0.0
Median Rank List Positionof First Resident Matched
YEAR
200120001999199819971996
Med
ian
ran
k
25
20
15
10
5
0
Median Rank List Position of Last Resident Matched
YEAR
200120001999199819971996
Med
ian
ran
k
40
30
20
10
0
PROGSIZE
4 or fewer residents
(p = .12)
5 or more residents
(p = .003)
Median Rank of Last Resident Matched by Program Size
The overall quality of medical students applying for a surgical residency has declined over the last six years.
Mean 2.7 – Disagree (P=.04)
The number of medical students wishing to go into general surgery has declined over the last six years.
Mean 3.4 – Agree (P=.01)
Activities of medical schools and medical school deans to encourage medical students to go into family practice or primary care has hurt recruitment for general surgery residents.
Mean 3.6 – Agree (P=.000)
Conclusions
• The USMLE Part I Scores are increasing over time
• The % of our PGY-1’s who are AOA is declining
• Big programs attract residents with higher board scores
Conclusions
• The applicant pool may be shrinking
• General surgery is not as competitive a residency to obtain as some other more lucrative and less rigorous careers in medicine
• Decreasing numbers of FMG’s applying, but more matching
• Going deeper into the rank list to fill
Conclusions
U.S. Surgical Residency Program Directors do not think that the quality of their categorical PGY-1 residents has declined, but they do feel that the applicant pool is shrinking, and that Medical School Deans are contributing to this decline in the desire of medical students to become surgeons.
Conclusions
• The popularity of general surgery as a specialty is declining– Increase in unfilled categorical PGY-1 spots– Decreasing number of programs needed to
rank to obtain a spot• If you are a U.S. senior medical student, there
is a 95% chance you can be a surgeon if you want to