Nephrology Goes All-In: An Update on the Match

In the first year of the All-In Nephrology Match, the number of participating programs and training tracks rose to the highest level since the specialty joined the National Residency Matching Program’s (NRMP’s) Medical Specialties Matching Program. Although there was a slight increase in applicants choosing nephrology, the recent trend of increasing numbers of unfilled positions and programs continued. Nearly 60 percent of training tracks and over 40 percent of positions were left open on Match day.

The vast majority of nephrology training programs participated in All-In and potential nonparticipation was circumscribed. NRMP’s final Match data report released on March 7 noted that a total of 140 programs offered 158 training tracks (Clinical, Clinical Research, Research, and Other) and a record 466 fellowship positions for appointment year (AY) 2016. All-In’s first year was therefore quite successful in increasing the number and percentage of nephrology fellowship positions offered through the Match.

Despite an increase in the overall number of candidates choosing nephrology (298, up from 252 in AY 2015), the number of non-US international medical graduates (IMGs) fell to its lowest level since Nephology entered the Match (100 candidates, down from 331 in AY 2009). This decline is of concern because IMG physicians have comprised a majority of nephrology fellowship candidates over the past 8 years. Numbers of candidates applying to nephrology training programs from other educational backgrounds were stable (US medical graduates and osteopaths) or rose slightly (US IMGs) over AY 2015.

The increased participation and rebound in candidates doesn’t obscure the shrinking pipeline of candidates choosing careers in nephrology. For every fellowship position offered in AY 2016, there were only 0.60 candidates, a marked decrease from 4 years ago when there were 1.1 candidates per fellowship position. The Match rate remained flat at 92.6 percent.

ASN Council has approved multiple initiatives to increase interest in nephrology careers at every stage of the educational continuum, such as the Kidney STARS and Kidney TREKS programs. ASN’s ongoing nephrology workforce research collaboration with George Washington University has provided insights into the current and future generations of nephrologists, and informed the kidney community on trends for specialty researchers identified as “in transition.” Recent publications have also highlighted the need for nephrology programs to consider resizing their training programs to optimize the balance between supply and demand for nephrologists, which should lead to an improved job market for graduating fellows.

Monitoring the Match

After the declining participation in the nephrology Match, the ASN Council unanimously approved an All-In Policy for the Nephrology Match in 2015. As the official sponsor of the Nephrology Match, ASN believes All-In is the best approach for the specialty in the long term and helps ensure all candidates: 1) have fair and equal access to programs, and 2) can examine the full range of training opportunities before making a final decision. Moreover, the All-In Policy provides programs with an equitable system to evaluate candidates on an orderly and transparent schedule.

As part of the move to All-In, ASN established the ASN Match Oversight Task Force to monitor outcomes, assess participation, and make recommendations to ASN Council (Table 1). Convened in December 2015, the Task Force reviewed available data from NRMP and the Electronic Residency Application Service (ERAS) and identified a limited number of programs potentially nonparticipating in ASN’s All-In Policy. ASN is following up with a small number of programs to discuss their participation in the Match, and solicit their input and concerns about the process and recommendations on how ASN can better support their efforts in training the next generation.

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New features in the AY 2017 Application Cycle

As announced in 2015, programs participating in the All-In Nephrology Match will be listed in, and have access to, ERAS starting with the AY 2017 application cycle (Table 2). Because ERAS and NRMP have different processes and timelines for administering their Match responsibilities, ASN is asking programs to sign a memorandum of understanding (MOU) to provide ERAS the information it needs to verify programs/tracks participating in the AY 2017 All-In Nephrology Match. Programs and training tracks that enter into the MOU by Wednesday, June 15, 2016, at 5 p.m. EDT will be available for candidates to apply to when ERAS opens on Friday, July 1. Programs that enter into the MOU after June 15 will be listed, but ERAS will not inform candidates of any additions.

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The ASN Match Oversight Task Force recommended, and ASN Council approved, extending eligibility for ASN benefits to participating programs, effective with the AY 2017 application cycle (Table 3). Additionally, ERAS has agreed to inform PGY-3 internal medicine residents that the Nephrology Match follows an All-In Policy. A series of emails will direct residents to ASN resources that can inform their consideration of additional subspecialty training and a career in nephrology. Finally, an annual census of fellows reporting for training in July will provide definitive data on nephrology training programs.

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ASN’s move to All-In will be followed by Infectious Diseases and Sleep Medicine this year, and other specialties are considering implementing similar policies. The level playing field All-In offers candidates in the Residency Match could someday be the norm for all specialties, giving candidates the best opportunity to make informed and unpressured choices about their careers.

For more information about the All-In Nephrology Match, please visit https://www.asn-online.org/education/training/match/ or contact nephrologymatch@asn-online.org.