Trends in USMLE residency positions

Aim

To find out the growth rate of residency positions in medical specialties over the last five years.

Methods

I compiled the data from NRMP Advance Data Tables Main Residency Match 2012. The difference in change of number of positions was calculated using the (Tn-T1)/T1 formula where T1 represents the first time point, which in this case is 2008 and Tn represents the nth time point which in this case is 2012. The formula was uniformly applied to the residency match position and the derived values growth coefficient (GC) was plotted on a linear graph.

I represented foreign medical graduate (IMG/FMG) friendly specialties (Internal medicine, Family Medicine, Pediatrics and Psychiatry) with diamonds. I gave second tier programs (Neurology, Anesthesia and Emergency Medicine), circles and surgical/semi surgical specialties (Pathology, Surgery, Obstetrics and Gyn), squares. Radiology was placed in semi-surgical group for graphical reasons.

Fig.1: Growth trends in Medical Specialties in the last five years

Interpretation:

As seen in the figure, the specialties show three distinct groups based on the growth coefficient. The ‘growth’ group comprises of Anesthesia, emergency medicine and neurology and internal medicine. These specialties have shown continued increase in number of positions each year. The more the positions are there to apply, the better the chance of being accepted into a program. Anesthesia has shown a remarkable growth in the number of positions (about 40%) while internal medicine has shown a modest growth of 8% from 2008 to 2012.

The second group called the ‘stagnation’ group has demonstrated neither an increase nor a decrease in the number of positions. This group comprises of psychiatry, pediatrics and family medicine (the three of the four pillars of IMG success). This is a worrisome trend because, if the number of positions in these do not increase the competition for the allocated positions is only going to worsen with each successive year. Pathology and General surgery (prelim) also belong to this group.

The third group of specialties is the ‘reduction’ or the ‘attrition’ group. This comprises of radiology and ob-gyn specialties. What is interesting is General surgery was trending to be a part of this group until 2011 but as can be seen an increase in number of available positions pushed it out of this group. Radiology has shown a remarkable reduction of residency positions every year. I believe that this self imposed attrition is soon going to reverse because there will be need for more radiologists. Read about the radiology staffing market, demands and trends here. 

One word of caution though, these represent growth curves and do not reflect the total number of positions available for applying. Thus as an example, even though the growth of family medicine spots has remained more or less the same in the last five years compared to anesthesia, the total number of positions in FM are far more than those in anesthesia.

Implications:

For medical graduates who are undecided regarding the choice of specialty, this growth rate data provides information regarding growing versus reducing fields. Given the intense competition for the few positions, it would be important to know where the competition is going to be the fiercest. Thus applying to specialties that are growing may increase the chances of being accepted.