The Match: five years later

Current state of the pain medicine match: perspective and an eye to the future

The National Resident Matching Program (NRMP) for pain medicine fellowships marked its 10th anniversary in 2023, coinciding with growing discussions within the Association of Pain Program Directors (APPD) regarding the program's future in the context of a recent decline of applicants into pain medicine. This letter explores the rationale behind reassessing the NRMP's utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match's benefits and ensure a stable future for pain medicine fellowship recruitment.

Internal Medicine Program Directors' Perceptions of the "All In" Match Rule: A Cross-Sectional Survey

BACKGROUND

Since 2013, the National Resident Matching Program (NRMP) has asked all programs to declare themselves to be "all in" or "all out" for the NRMP. Before this rule was enacted, program directors who were surveyed expressed concerns about what they anticipated with the change, including resources for increased applications and potential delays with residency start times.

OBJECTIVE

This study investigated the positive and negative effects of the rule change on recruiting seen from the perspective of internal medicine (IM) program directors.

METHODS

In this mixed model cross-sectional survey, Accreditation Council for Graduate Medical Education-accredited IM program directors were surveyed regarding their impressions of the impact of the policy change. Data were aggregated using constant comparative analysis.

RESULTS

A total of 127 of 396 (32%) IM program directors responded, and 122 of 127 (96%) identified their program as "all in." A total of 110 respondents expressed impressions of the rule change, with 48% (53 of 111) reporting positive responses, 28% (31 of 111) neutral responses, and 24% (27 of 111) negative responses. Programs with higher percentages of visa-holding residents had lower positive responses (37% [22 of 60] versus 61% [31 of 51]). Resident quality was felt to be unchanged or improved by most program directors (93%, 103 of 111), yet 24% (27 of 112) reported increases in delayed start times for visa-holding residents. Qualitative analysis identified increased fairness, at the expense of an increase in program resources as a result of the change.

CONCLUSIONS

A slight majority of residency programs reported a neutral or negative impression of the rule change. Since the rule change, program directors noted increased application volume and delayed residency starts for visa-holding residents.

Improving the Nephrology Match: the Path Forward

The Fellowship Match process was designed to provide applicants and program directors with an opportunity to consider all their options before making decisions about post-residency training. In a Match, applicants can choose the programs that best suit their career goals, and program directors can consider all candidates before preparing a rank order list. The Match is a contract, requiring obligations of both programs and applicants to achieve success, ensure uniformity, and standardize participation.

Trends in applications for thoracic fellowship in comparison with other subspecialties

BACKGROUND

Length of training (LOT), lifestyle, and decreasing reimbursement have been credited with contributing to the decline in applications to thoracic surgery (TS). Other surgical specialties share similarities in LOT and lifestyle; however, trends in applications for these specialties have not been compared. One cannot look at applications to TS without examining concurrent changes in the pool of residents finishing general surgery. To clarify the relative impact of LOT, lifestyle, applicant pool, and reimbursement on applications to TS, we analyzed these trends concurrently.

METHODS

National Resident Matching Program residency and fellowship match placement data (1997 to 2012) for general, TS, pediatric, transplant, and vascular surgery, including integrated TS and vascular surgery, were analyzed. Corresponding trends in reimbursement were analyzed from Medical Group Management Association data (1996 to 2010).

RESULTS

During the study period, percentage of medical students matching into general surgery has remained relatively constant (4.9% to 5.5%). Applications for TS have declined since 1997. Applications for pediatric and transplant surgery have increased. Vascular surgery has remained relatively constant, with an applicant to position ratio approximately 1:1. Integrated programs (thoracic and vascular) have been popular; 3 to 7.4 applicants per position and 2 to 3.47 applicants per position, respectively. Cardiovascular surgery median salaries have remained largely the same; salaries for general thoracic, pediatric, transplant, and vascular surgery have increased (1.95% to 7.13% per year) although cardiovascular surgeons continue to have the highest median salary.

CONCLUSIONS

Given the above data, it does not appear that LOT is the critical issue associated with the decline in fellowship applications for TS. The increased demand for integrated training programs may be reflective of other factors rather than LOT. The success of abbreviated programs in training competent thoracic surgeons has not yet been determined. Given that LOT does not appear to affect applications to surgical specialty, we may be able to maintain applications to the specialty without compromising LOT.