Featured topic and speakers
Ahead of Match Day, the NRMP's Chief Operating Officer Laurie Curtin, PhD, offers insight on recent Match trends that may ease stress for eager residency applicants.
Speakers
- Laurie Curtin, PhD, chief operating officer, National Resident Matching Program
- Brendan Murphy, senior news writer, American Medical Association
Host
- Todd Unger, chief experience officer, American Medical Association
Listen on the go to the full episode on Apple Podcasts, Spotify or anywhere podcasts are available.
Transcript
Curtin: If we want to look at it by applicant type, we can see that the placement rate for U.S. MD seniors who certified rank order lists last year was 97.9%. And for DO seniors, it was 98.5%. So, I hope that would be encouraging to applicants who listen to this.
Unger: That was Laurie Curtin, chief operating officer at the National Resident Matching Program, or NRMP, an expert on Match, Laurie dives deep into historical data around Match rates and why residency applicants needn't worry. She talks about Match rates across different specialties and among international medical graduates. Don’t miss out on this insider information. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to Making the Rounds. I'm Brendan Murphy, senior writer at the AMA. It's Match season and if you're a residency applicant, you're waiting to find out whether you've matched, which you'll find out on March 17. And of course, then you'll find out where you've matched on Match Day, which is Friday, March 20. Here today to help assuage some Match anxiety is National Resident Matching Program Chief Operating Officer, Laurie Curtin. With over 20 years of experience with the NRMP, and a PhD, she is among the foremost experts on the Match process. Today we're talking about past NRMP data and how it may help inform what happens in a few weeks. We're grateful to have you here today, Laurie. Thanks for being with us. How are you doing?
Curtin: I'm doing well, Brendan, and thank you for having us, us being the NRMP. We're glad to be here with you.
Murphy: As I said off the call, I've been on the medical student beat for many years and I'm a big fan of the NRMP.
Curtin: Wonderful.
Murphy: So glad we could connect and talk about this important topic.
Curtin: Me too.
Murphy: I think a good place to start is talking about some of the recent data trends related to the Match and why they are generally encouraging for applicants.
Curtin: Sure. You know, despite changes in the size and scale of the Match over time, I mean, we've brought in almost 5,000 more applicants over the past five years. We just sort of look at a five-year trend and more than 4,000 additional PGY-1 positions. So we say every year, you know, the Match continues to grow. But despite those changes in size and scale, you know, Match rates remain remarkably consistent across pretty much all of the applicant types.
You know, U.S. MD and DO seniors in particular achieve Match rates that are quite high year over year, anywhere from 90 to 94 % when the algorithm is processed. So those are really, really good numbers. We shared a perspective with you last week. I know my team was working with you on an article that you're working on for AMA, but I wanted to highlight it again here as well for listeners that the NRMP recently added a placement rate metric to some of our data reports. And the placement rate combines outcomes from when the matching algorithm is processed with the numbers of applicants who accept offers during SOAP, or the Supplemental Offer and Acceptance Program.
And so this is a new metric. It gives a little bit more of a comprehensive view of how the NRMP is able to support applicants as they transition into residency, not just with the algorithm, but certainly through the Match Week SOAP process as well.
When we look at the entire pool of applicants who registered for, let's say for the 2024 Match, if we look at last year, 79.7 % of those applicants obtained a position either through the Match or through SOAP when we look at that combined placement rate. And 99.6 % of positions were filled. But if we even narrow that a little bit more, not just the applicants who registered, but those applicants who registered and also submitted a certified rank order list, for processing in the 2024 Match, the placement rate rises to 85.1%. And then we can look at that even another way. If we want to look at it by applicant type, we can see that the placement rate for U.S. MD seniors who certified rank order lists last year was 97.9%. And for DO seniors, it was 98.5%. So I hope that would be encouraging to applicants who listen to this. That, you know getting ready for the Match, moving through the Match, submitting those certified rank order lists really does work, highly and successfully well at getting applicants into training programs for residency. So just want to take one more angle though and sort of give another sort of way in which Match data can be leveraged if that's okay. Because those numbers are very specific to the Match, how the Match works. But you know, one of the things that we were super excited about when we produce the data every year for the Match is that it also really does reflect broadly on some of the national conversations and trends that we see in the physician landscape. And the NRP data is a really good source for that. And two ideas really come to mind. So, I'm going to quickly share two. One is emergency medicine. Maybe you were sort of following some of the trends year over year, but in 2023, emergency medicine really had sort of a little bit of a hiccup in the Match.
The fill rate that year for emergency medicine was 81.5 %, down from 92.5 % the year before. And so when those things happen, we always internally stop and sort of look and reflect like what may be driving that change. Now, to be fair, one year does not a trend make, right? It's one year of data, but what might be going on nationally or even within our UME/GME community, that space that might lend some idea. Certainly COVID, we were in the throes of COVID—very, very challenging, very difficult for frontline health care providers. Certainly, emergency medicine physicians fall into that space. And so that's something we're able to reflect on with the data that we see. Moving into 2024 Match, there was a really sizable rebound in emergency medicine. They offered over 3,000 positions, which was actually a slight uptick from the year before, and they had a fill rate of 95.5%. So again, Match data just helps us sort of look at what's contextually happening in our community, how might the data really reflect on some of the things that we're seeing within the health care workforce or the physician workforce more broadly. The second example I want to give quickly was interest in OB-GYN. So with the Dobbs decision that was handed down by the Supreme Court in 2022, there was a really increased interest or focus in how OB-GYN might move through the Match. Why might we see some changes in performance for programs in that particular specialty?
But in the 2024 Match and beyond, 23 and 24, we haven't really seen a change. OB-GYN remains very competitive. Its fill rates have remained very high. And even if we go into fellowship and the subspecialty level, we actually see an increase in applicants pursuing those specialties. So I just give those two examples as other ways for listeners to sort of look at the data, reflect on the data. It certainly speaks to the actual Match performance, but also some things that might be happening nationally or within our community.
The data is an important bellwether, think, in RMP data of trends and patterns that inform some of the local conversations we're having. And it's always the primary source for ranking and Match outcomes, so applicants should always seek out and feel very comfortable in the data that they see in our reports.
Murphy: And the data is very comprehensive at the NRMP website. You can find just about anything you're looking for. One interesting note is that emergency medicine in 2023 was an outlier.
Curtin: Absolutely.
Murphy: There is outliers. So even as we talk about the past data, it's not a guarantee that things will work the same in 2025, of course.
Curtin: Absolutely. It is, I think it's very sensitive to the changing interests of applicants. What is it they want to pursue? Where is it they're going? What's happening nationally? How is it placing either strains or making real demands of the physician workforce? You can sort of trace that back into the Match data. But to your point, and it's an excellent one, things are very fluid year over year. Things can change. And one of the jobs we take seriously is how can we bring that information to the community and inform the community so they know how to rely on our data and use that to make whatever decisions certainly, you know, would be applicants, current medical students, how do they use that information to make informed decisions about where it is they want to train or in what specialty.
Murphy: So now that we've put the caveat out there, I'd like to ask some specialty-specific data questions if you're okay with that.
Curtin: Yeah, I'll do my best.
Murphy: What's one key trend for U.S. MD seniors to keep an eye on, maybe one that's encouraging?
Curtin: Oh, a key trend. Well, you know, we say it every year. I sort of referenced it already. You know, for MD seniors, PGY-1 Match rates, know, Match rates to that first-year postgraduate year of training are highly consistent over decades. And I mean, decades. The Match rate for PGY-1 Match rate for U.S. seniors hovers right between 92 and 94% in the past four years. There's been a change of less than one percentage point.
So, it is something that MD seniors should comfortably rely on. Their PGY-1 Match rates are highly consistent over time. That's a key trend I think hopefully is reassuring. Takes a little bit of the edge off, but not a lot of fluctuation. Even though we do, almost year over year see more MD seniors coming into the Match. There might be some slight fluctuations, but it's not like that's a static population each year. There is some dynamic quality to it, and it does change and yet those Match rates are still consistently quite high.
Murphy: I'd ask the same question of DO seniors.
Curtin: And I give a slightly different response, I think, for DO seniors. We see the Match rates are very strong. The PGY-1 Match rate for U.S. DO seniors in 2024 was 92.3%. That was an all-time high for DO seniors and certainly puts it on par with the Match rate for U.S. MD seniors. So it's quite strong. Since 2019, the DO Senior PGY-1 Match rate has increased over four percentage points, even with marked increases in the number of DO seniors in the Match. We've had about an increase of 1,400 U.S. DO seniors come into the Match since 2020. So guess my message for them was that growth, that uptick continues to, we continue to see it each year. It's very strong year over year for DO seniors. And like I said, comparable to the MD Senior Match rate at this point.
Murphy: And is there a noteworthy applicant data point for IMG applicants?
Curtin: I would say probably something folks may not think about as readily with our IMG population, their Match rates are different from the U.S. senior population. Anybody who's looked at our data reports can see that pretty readily. For non-U.S. citizen IMGs, we do see anywhere from a 55 to maybe low 60% Match rate. For U.S. citizen IMGs, the Match rate is higher. But I think probably a takeaway there is that the IMG community is really supportive of primary care, specialties in particular. In 2024 alone, more than 40 % of the categorical, those first-year full-course training internal medicine positions were filled by international medical graduates. This is particularly true for our non-U.S. citizen IMGs, whose percent matched to categorical internal medicine programs has increased from 24.3 % in 2020 to 30.3 % in 2024. So primary care specialties rely pretty heavily on the international medical graduate community. And that's still a very critical source of specialty care that we provide across the country.
Murphy: How has the competitiveness of the Match as a whole changed over time and particularly how has it changed for traditionally competitive specialties?
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Curtin: As you and I sort of referenced a little bit earlier, there are ebbs and flows during each Match season. Some are more pronounced, like emergency medicine that I referenced back in 2023. But we certainly do see ebbs and flows, even if you look at broader sort of scope or scale, a five or a 10-year trend, specialties that might have been considered competitive at one point, maybe are less so five or 10 years down the road, only to then see that uptick come back. So, everything has a bit of a cyclical nature to it. That being said, the perennials, the surgical subspecialties—thoracic surgery, obstetrics and gynecology, plastic surgery, neurological surgery, derm, orthopedic surgery—those remain year over year, highly competitive. Again, we have an overall high PGY-1 Match rate for U.S. MD and DO seniors, but the number of applicants in those particular groups, in particular, the number of applicants pursuing those surgical subs usually exceed the number of positions available each year. So, I wouldn't say that the specialties have kept up with that interest. There's always more interest among seniors in those surgical subs specialties than there are positions to fill them. The number of U.S. seniors applying to PGY-1 positions that we see when we track, by apply, see when we talk about putting them on rank lists, that's what we mean by an applicant, they're ranking those particular specialties, germ and orthopedic surgery, definitely exceed the number of available positions. So we do see some ups and flows, but the surgical subspecialties do remain very competitive and have very high fill rates year over year.
Murphy: Is it more common in those competitive specialties, and I know in general it has become more common, for someone to be a dual applicant in two specialties? And how does that fit into the overall Match rate?
Curtin: Right, well Match rate is just looking at when the algorithm is processed, what position and what specialty do applicants find themselves for that July 1 start of training. But the NRP has long encouraged applicants to look at their candidacy honestly.
And if they're looking at a competitive specialty, certainly the surgical subspecialties, but psychiatry does very well. Lots of specialties do very well in the Match. Again, the fill rate is very high when we process the algorithm. But we really want candidates to consider their candidacy honestly. And if they need to consider a mix of specialties, we encourage them to do so. Because we certainly, at the end of the day, we want applicants to be able to enter that training and really launch their careers as physicians.
And when the number of applicants interested in the specialty exceed the number of available positions, and again, those data are pretty easy to read, and our results in data, then we certainly would encourage them to have another specialty. Hopefully there's something else that sort of lights a fire for them, and they're willing to apply and go interview with those programs as well so they can make some more well-rounded choices when it comes to submitting that rank list. It's not at all uncommon, no.
Murphy: That question sort of feeds into the next one, which is a broader question. Are applicants becoming more strategic? And is that leading to better outcomes?
Curtin: You know, that's a good question. That's hard for the NRMP to answer fully because we don't, the application process, you know, that falls outside of our purview. So you know, application data isn't something that I have access to that way and can't really look at strategy or trends. And certainly, there are now multiple application service providers in that space. That being said, you know, the NRMP's focus on collecting and reporting applicant demographic data, we do so by preferred specialty, we do it by matched specialty, we do it by SOAP, hopefully provides applicants the ability to really drill down and customize the assessment and understanding of programs or specialties in the Match and where it is they may want to train. We want those offerings to sort of empower applicants to make more informed choices as well as help programs, because the data's available to both, help programs understand where and how they may want to refine their recruitment efforts. So I don't know that it is something we can say that they're more strategic with their applications, but certainly the availability of good data and good resources hopefully helps them make better-informed decisions that would trickle down into strategies that work for them and get them into the training programs that they want.
Murphy: Well, this is specialty dependent, but we have seen in even some of more competitive specialties, with the prevalence of signaling, that application totals have gone down. Are applicants ranking fewer programs? Does that not necessarily correlate?
Curtin: It doesn't necessarily correlate because there is still, there's … you know, lots can happen between the summertime when the majority of applicants will start to put their applications together and the specialties they're interested in and the programs that they're interested in, but a lot can happen over the course of the interview, the interview trail, and where they apply an interview may fundamentally change their perspective by the time they're ready to rank, right? There's not necessarily a uniform or a lateral movement through all of that. That's sort of the point of the interview, right? You apply, you interview, and then where you thought you might really want to be may change over the course of those interviews. So certainly, we do see. We've certainly been aware and working with the AAMC on some research on preference signaling, we certainly do see that there probably is real impact at the interview level. How that actually translates into ultimate changes in ranking behavior isn't something we're as clear on just yet. That is research that is in flight. But I would say we have not seen fundamental shifts in the length of rank order list, that is data we also post to our Match data page on www if people are interested. And there is usually a slight modification, a slight increase in the length of rank order list over time. So, I do think signals if they're having their impact at the interview stage, which is really what they're designed to do, I think could be effective. How that translates into actual ranking decisions is a little less clear. I think it's just going to take more time with preference signaling in the space and being able to get the data and run sort of the research on it to see. But rank order lists, the length at least, are fairly stable over time. They uptick just a little bit year over year.
Murphy: Are there specific factors such as new residency programs or maybe changes in applicant behavior that are improving the chances of matching? I know you highlighted that chances are pretty good generally.
Curtin: Right, I mean, chances are pretty good. Just about every year, the NRMP onboards more programs and positions and more applicants. We always say this year is the biggest Match in NRMP history. And again, as you allude to, the Match rates still remain pretty consistent, particularly for U.S. seniors. We certainly see more variability in Match rates for IMGs. I'm hopeful that the data and research reports that the NRMP releases are helping applicants make those more informed decisions, like we talked about earlier. We saw during COVID that many programs made concerted efforts to build and share more information on their program websites online. And it's possible that that's been sustained. Certainly, the more information applicants have access to about programs, their missions or their purpose, the patient populations they serve.
I think are going to make it easier for applicants to gather the information that's going to help them determine what's really good alignment for their needs and purposes. The NRP can't unilaterally improve an applicant's chances of matching since they're fully in control of their ranking decisions and the list that they submit to the NRP. So, a lot of that rests with them when those final decisions are made. But we remain laser-focused really on ensuring that the Match experience remains strong and equitable. So last year, as an example, NRMP sort of took it upon itself to convene the various application service providers, bring them together, consider how to ensure that the transition process remains as seamless as possible for applicants, particularly with SOAP, and to work together to explore some possible data sharing process improvements. For its part, the NRMP is building some APIs, some automatic data exchanges with the application service providers so that we can effectively and efficiently transmit some targeted applicant data. Like I said, in particular with SOAP, when those applicants learn on Monday of Match Week that they don't have a position wanting to make sure that everybody in that transition space is working together and working with the NRMP so that that process can be as easy as possible for unmatched applicants. That doesn't directly improve Match outcomes. I do understand that, but I am hopeful that it conveys that the NRP is committed to that applicant's experience. We want their Match experience to be as easy and as transparent as possible. And so hopefully that does have a trickle down at least that navigation of the process helps applicants feel more comfortable. They're more encouraged. They feel more informed. So that when they get their results in March, hopefully, it's good news and they're excited about where they're going to be in July.
Murphy: Probably worth mentioning, and I've spoken with some other NRMP staffers recently about the algorithm, that the algorithm is very applicant-forward.
Curtin: Thanks. It is, it's what we call an applicant-proposing algorithm. what that really means is that when the algorithm kicks in to start its job, it's always going to start with the most preferred program on an applicant's rank order list, and it will work to place the applicant into that most preferred program. And it will work its way down an applicant's rank order list, always attempting to get the applicant into the most preferred program that it can, in a program that also prefers that applicant. So that's what it means by applicant proposing. The NRMP, again, it sort of fits with the philosophy of the NRMP as being very applicant-centric. This is an experience for applicants. want this, what is a rite of passage, to be as easy to navigate, as straightforward, as equitable as possible. And one of the ways to ensure some of that is to rely on an algorithm that is applicant proposing. And it has been since the mid-'90s. We did make some slight adjustments to the algorithm in the mid-90s to make sure that it really was starting with that most preferred program on an applicant's list and really trying to get them into that program. So it is, that is something dynamic about the algorithm that we would continue to push forward.
Murphy: Are there particular specialties in recent years, I know you mentioned emergency medicine, that have become more or less accessible for applicants?
Curtin: You know, one of the ways that we can look at that is we sort of, as I said, we sort of can look at where … what specialties applicants are actually ranking and do we start to see changes or shifts in those behaviors over time. I mean, some of it is the actual fill rate. Like I said, the example I gave earlier about emergency medicine, right? There was a significant decline in 2023 in the number of positions they filled. In 2024, we saw it with pediatrics.
The fill rate in 2024 was still high for pediatrics, but it decreased from 97 to 92%. There were 251 unfilled positions in 2024 in pediatrics compared to 88 unfilled positions in 2023. So strange, not really sure what that is. And again, one year does not a pattern established. So certainly, we're going to look at it this year and maybe even 2026 to see if we can identify if that's a pattern and what might be ... be causing that. But one of the ways to sort of assess what those shifts are is where are applicants sort of ranking? Where are the specialties they're most interested in? And we could see for U.S. MD seniors in particular, there was a decline in interest in pediatrics in 2024. About 200 fewer MD seniors ranked pediatrics programs in 2024. If I look at DO seniors, I could see a decline as well, not as big—less than 100. But that's just another way of sort of looking our interests moving to other specialties. Certainly, that will have an impact on the fill rate for specialties like pediatrics. Again, a 92 % fill rate is nothing to sneeze at, but it is a slight change from year over year. And so, we continue to monitor the specialties that way. We continue to look at where applicants are ranking, what specialties, where we can see some shifts over time that does sort of inform how program or specialty performance might be impacted. That again, sort of go back to your original question, might really then make a statement about what's accessible or what's more or less competitive and how the specialties may shift to include or sort of embrace a wider range of IMG candidates if that's where some of the momentum may be. So, these are just other ways to sort of look at the data that comes from NRP, certainly, that's things we do internally after the algorithm is processed to really try to, again, understand that landscape and be able to give a broader context back to the community.
Murphy: This Match cycle is approaching its conclusion, but the Match process is always ongoing for someone.
Curtin: True.
Murphy: Looking forward and speaking to future applicants, what advice would you offer about maximizing your chances to Match next year or when your time comes?
Curtin: When your time comes. You know, I don't know that the NRMP would have radically different advice. There's good advice out there. Certainly there are organizations and folks really invested in the transition. As I said, we look at it as a rite of passage. We want it to be the best that it can be for the applicant community, but also the programs and the schools that support those students. But a couple of things certainly come to mind. Do the research, right? Make sure that that that applicants are looking at the programs and the specialties they're interested in. Visit those websites, maybe participate in some listservs just to get a sense of what those programs and specialties are about. What is their mission? Does that align with what you want to do? What is the focus? School advisors are a wealth of information as are former grads. What information or insight might they have that they'd be willing to share? Use available resources, right? We have wonderful data. I've spent quite a bit of time today talking about our data.
And a lot of that is customized so that applicants can really go to our website, open some of our resources and say, I want to know about programs that meet X, Y, Z criteria. Those are my criteria. How does that inform me about where I might find alignment? What do their Match outcomes look like? So some of it's just doing the research, being informed. I would say applicants always assess your needs. Be honest with what it is you think you want to do and give yourself grace that that may change over the course of the interview cycle. Do you want big programs or small programs? Rural or urban? Is research something you like or something you may not want to be as involved in? Know in your heart what you think you're interested in, but give yourself flexibility to allow that to evolve over the course of the Match cycle because the programs you meet, the residents you meet may really affect how you think about your role in your future and where you want to go.
The age-old wisdom from the NRMP is to rank smartly. We're always going to encourage applicants, rank in order of your true preference. Just wherever you interview, what excites you, what really fills you with some optimism and looking forward to training, rank according to those feelings and impressions. As we talked about a little bit earlier, if you're going for a really competitive specialty, maybe consider some programs in a different specialty so that you're sort of creating a more well-rounded approach when the algorithm does its work. And include all the programs where you interviewed. If you're willing to train there, make sure that you've got a good healthy length of rank order list, so the algorithm has ample opportunities to get you into a program and get you on your way. But I think the most important for me when I think about talking to applicants is to remember that it's not just about the transition. We know that the last year of medical school, there's a lot going on. We work hard to make Match Week and Match Day fulfilling, know that the schools do as well. But we also want applicants to thrive where they land. So residency is certainly, it's a critical time. It's sort of the launch of a physician's career. And matching is just one component, right, of that. We want to make sure that we're here and giving advice that helps applicants take the steps that I've mentioned, that land in a program where you can learn, where you can connect, where you can thrive, you can grow into the physician that you want to be. So the Match is important, but it's just one step. And the future is really bright for so many applicants. And if they take some of these steps and recognize that the transition is important, but it's just one piece of what will be many exciting adventures, I think that's a healthy perspective to hold onto.
Murphy: That is a healthy and valuable perspective. you have anything else you'd like to say to our audience of current and future applicants?
Curtin: Just remember that the NRMP is here for you. We have so many different offerings. I've spent most time today talking about our data, how to really dig into the data and hopefully find some encouragement and some insights that help inform navigation through the Match. But we also have wonderful videos on our YouTube channel that are put together by current residents and program directors. They offer great advice to applicants moving through the process. We have lots of policy resources so that you understand how to move through the Match. We have research and white papers that explore some important questions about the transition to residency. Some of that is like some of the preference signaling that we talked about. And we have a superb client support team that is ready to answer questions, any support that folks need. So one of our highlights every year, folks may not know, but one of the highlights for NRMP staff is watching live stream, live streams of Match Day ceremonies. We are there every step with you. We want to help. We want to make sure that the Match is the best experience that it can be. And I think I speak for everybody at NRMP that that is a mission and a focus that we take very seriously. So, we're with you every step of the way. We hope you won't hesitate to reach out if you've got questions or needs and we will do what we can to make the Match experience the best it can be for you.
Murphy: Laurie, it's been a pleasure having you on the show. Thank you so much for joining us.
Curtin: Well, thank you, Brendan. I've enjoyed myself immensely. Thanks so much.
Murphy: And for our listeners who want to get more acclimated with the data, visit nrmp.org/match-data. I'm AMA Senior News Writer Brendan Murphy. Thanks for listening to Making the Rounds.
Unger: Don’t miss an episode of this special series as you prepare for Match Day. Subscribe to Making the Rounds on your favorite podcast platform or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
