The Short Long View: Trends in the Medical Specialties Match

By Kurtis Pivert

Over the past 4 years, nephrology’s performance in the National Resident Matching Program (NRMP) Medical Specialties Matching Program (MSMP) has caused concern among stakeholders in the kidney community. In appointment year (AY) 2016 alone, 59% of nephrology tracks and 41% of fellowship positions were left unfilled on Match Day.

Although not definitive, Match data provide indicators for determining specialty choice trends among internal medicine (IM) residents. So how does nephrology compare over the short term?

Visualizing demand as the percent surplus or deficit of applicants to available positions contrasts specialty performance in the Match (Figure 1). Note the top three specialties are outliers (hematology, oncology, and pulmonology). The number of these exclusively focused programs have decreased since their allied specialties (hematology–oncology and pulmonology–critical care) began merging in 1994.

Figure 1: Percent Surplus/Deficit of Fellowship Applicants to Positions NRMP MSMP 2009–2016

Percent surplus (blue dots, maximum) or deficit (red dots, minimum) between candidates and available positions in the MSMP Match. Source: National Resident Matching Program. http://www.nrmp.org/match-data/fellowship-match-data/. Code: Tufte in R. http://motioninsocial.com/tufte/

Excluding outliers, there’s a slight overall downward trend across most of the remaining specialties. Since nephrology joined the Match nearly every applicant peak occurred in 2009 or 2010, which may be attributable to the effects of the Great Recession. Since then surpluses among applicants for more popular career paths have narrowed, while deficits for nephrology and infectious diseases have grown. Interestingly, IM specialty applicants have increased 27% during this period, outpacing the incremental growth in IM programs and residents (4% and 7%, respectively) over the same time for which Accreditation Council for Graduate Medical Education data was available (AY 2009–2014).

Focusing on nephrology Match data, the accelerating decline in nephrology applications is stark (Figure 2). Until AY 2013, the number of nephrology applicants outpaced demand even as programs were expanding positions. While the number of fellowship positions in the Match began shrinking in AY 2014, this did not match the pace of the reduced number of potential candidates. (Note the uptick in positions in AY 2016 is directly attributable to implementation of ASN’s All-In Policy.)

Figure 2: Results of the Nephrology Match 2009–2016

Percent surplus or deficit (bars) between applicants (blue/red boxes) and available positions (gray boxes) in the nephrology Match. Source: National Resident Matching Program. http://www.nrmp.org/match-data/fellowship-match-data/


 

Again excluding outliers, a comparison of raw numbers across specialties shows a slight overall downward trend in applicants compared to incremental growth in fellowship positions (Figure 3). (Note the scales on the y axis are not consistent across specialties.) 

Figure 3: Applicants and Positions by Specialty NRMP MSMP 2009–2016

Numbers of applicants represented by bold blue line, and positions by thin gray line. Scales on y axis are not consistent across specialties. Source: National Resident Matching Program. http://www.nrmp.org/match-data/fellowship-match-data/


 

One important limitation of this brief analysis is the NRMP data represents only the Match results, which may not reflect the actual number of fellows in training for any year, especially for specialties that may fill open slots in the scramble.

So what do these trends mean for Match Day 2016? Among the factors influencing the potential outcomes are the number of IM residents choosing to specialize. Between AY 2008 and AY 2014 the ratio of IM residents opting for a specialty to IM residents overall has been flat at approximately 40%. Yet hospitalist positions continue to attract graduating IM residents (as well as nephrology fellows). This, along with an analysis of trends in IM residency positions, are among potential influencing factors that ASN will be studying as part of its ongoing nephrology workforce research.

For nephrology, preliminary data from the Electronic Residency Application System showed a slight decline among fellowship applicants to the specialty year over year, although a larger decrease in applications compared with AY 2016. ASN and Kidney News Online will be monitoring the AY 2017 application cycle and the Match Day results on December 7.

Do you have questions or suggestions for workforce research? Let us know what knowledge gaps should be assessed: info@kidneynews.org

Learn more about all ASN's programs focused on supporting and building the nephrology workforce. 

Category:
Author:
Kurtis Pivert
Body:

Over the past 4 years, nephrology’s performance in the National Resident Matching Program (NRMP) Medical Specialties Matching Program (MSMP) has caused concern among stakeholders in the kidney community. In appointment year (AY) 2016 alone, 59% of nephrology tracks and 41% of fellowship positions were left unfilled on Match Day.

Although not definitive, Match data provide indicators for determining specialty choice trends among internal medicine (IM) residents. So how does nephrology compare over the short term?

Visualizing demand as the percent surplus or deficit of applicants to available positions contrasts specialty performance in the Match (Figure 1). Note the top three specialties are outliers (hematology, oncology, and pulmonology). The number of these exclusively focused programs have decreased since their allied specialties (hematology–oncology and pulmonology–critical care) began merging in 1994.

Figure 1: Percent Surplus/Deficit of Fellowship Applicants to Positions NRMP MSMP 2009–2016

Percent surplus (blue dots, maximum) or deficit (red dots, minimum) between candidates and available positions in the MSMP Match. Source: National Resident Matching Program. http://www.nrmp.org/match-data/fellowship-match-data/. Code: Tufte in R. http://motioninsocial.com/tufte/

Excluding outliers, there’s a slight overall downward trend across most of the remaining specialties. Since nephrology joined the Match nearly every applicant peak occurred in 2009 or 2010, which may be attributable to the effects of the Great Recession. Since then surpluses among applicants for more popular career paths have narrowed, while deficits for nephrology and infectious diseases have grown. Interestingly, IM specialty applicants have increased 27% during this period, outpacing the incremental growth in IM programs and residents (4% and 7%, respectively) over the same time for which Accreditation Council for Graduate Medical Education data was available (AY 2009–2014).

Focusing on nephrology Match data, the accelerating decline in nephrology applications is stark (Figure 2). Until AY 2013, the number of nephrology applicants outpaced demand even as programs were expanding positions. While the number of fellowship positions in the Match began shrinking in AY 2014, this did not match the pace of the reduced number of potential candidates. (Note the uptick in positions in AY 2016 is directly attributable to implementation of ASN’s All-In Policy.)

Figure 2: Results of the Nephrology Match 2009–2016

Percent surplus or deficit (bars) between applicants (blue/red boxes) and available positions (gray boxes) in the nephrology Match. Source: National Resident Matching Program. http://www.nrmp.org/match-data/fellowship-match-data/


 

Again excluding outliers, a comparison of raw numbers across specialties shows a slight overall downward trend in applicants compared to incremental growth in fellowship positions (Figure 3). (Note the scales on the y axis are not consistent across specialties.) 

Figure 3: Applicants and Positions by Specialty NRMP MSMP 2009–2016

Numbers of applicants represented by bold blue line, and positions by thin gray line. Scales on y axis are not consistent across specialties. Source: National Resident Matching Program. http://www.nrmp.org/match-data/fellowship-match-data/


 

One important limitation of this brief analysis is the NRMP data represents only the Match results, which may not reflect the actual number of fellows in training for any year, especially for specialties that may fill open slots in the scramble.

So what do these trends mean for Match Day 2016? Among the factors influencing the potential outcomes are the number of IM residents choosing to specialize. Between AY 2008 and AY 2014 the ratio of IM residents opting for a specialty to IM residents overall has been flat at approximately 40%. Yet hospitalist positions continue to attract graduating IM residents (as well as nephrology fellows). This, along with an analysis of trends in IM residency positions, are among potential influencing factors that ASN will be studying as part of its ongoing nephrology workforce research.

For nephrology, preliminary data from the Electronic Residency Application System showed a slight decline among fellowship applicants to the specialty year over year, although a larger decrease in applications compared with AY 2016. ASN and Kidney News Online will be monitoring the AY 2017 application cycle and the Match Day results on December 7.

Do you have questions or suggestions for workforce research? Let us know what knowledge gaps should be assessed: info@kidneynews.org

Learn more about all ASN's programs focused on supporting and building the nephrology workforce.