Results of the 2001 Match:
A Shot Across the Bow?
Joseph B. Cofer, MD, FACS
Professor of Surgery
Program Director
Universi...
• Applications to the nation’s medical schools fell
3.7% in 2000 in the fourth straight year of decline
• The decline was ...
Women constituted 43% of U.S. graduates in
2001 (up from 42.6% in 2000) and 46% of total
first year enrollment (up from 45...
Nursing Vacancy Rate
University of Cincinnati Hospital > 20%
Erlanger Hospital, Chattanooga, TN 8.6%
Estimated National Ra...
The average age of a registered nurse in the U.S.
in March 2000 was 45.6 years.
Associated Press, Sept. 9, 2001
“If current trends continue, the nation will face a
shortage of half a million nurses by 2020. The
nursing shortage in our...
• Decreasing medical school applications
• Changing demography of applicants
• Nursing shortage
• Shortage of ancillary pe...
“There is a freight train headed down the track
and it’s pointed directly at the fragments of what
previously was a good t...
Conclusions
The environment has changed!
– Worsening nursing shortage
– Decreasing medical school applicant pool
– Increas...
U.S. Seniors Matched to
PGY-1 General Surgery
891
928
915
890
883
853
840
874
820
760
780
800
820
840
860
880
900
920
940
...
57
45
39
31 35
55 55
73
92
0
10
20
30
40
50
60
70
80
90
100
1993 1994 1995 1996 1997 1998 1999 2000 2001
PGY-1 General Sur...
Number of Programs Ranked by U.S. Senior
Students to Obtain a Categorical PGY-1 Position
in the Match (Total Applicants In...
Match Results for U.S. Seniors Who Choose
One Type of Specialty (General Surgery)
Students
Matched
Students
Unmatched
Ttl ...
Ratio of U.S. Applicants Choosing a Specialty
with the Number of Categorical Positions
Available in that Specialty – 2001 ...
Positions Ranked and Filled in 2001 by
U.S. Senior Students
No. Ranks /
Position
No. Ranks /
Position
8.2
10.4
10.6
11.2
1...
Old vs. New Study
• Original study (1996 – 1999)
– 90 programs (1,312 residents)
Am J Surg 181(44);2001
• New study (1996 ...
Total Residents in Study
(% of Residents Matched That Year)
1996 1997 1998 1999 2000 2001
Old
Study
305
(30.4)
323
(32.0)
...
230
YEAR
1999199819971996
MeanPart1score
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents
Program...
Programs From Original Sample
Not Providing 6 Years of Data
YEAR
1999199819971996
MeanPart1score
230
225
220
215
210
205
2...
Programs Providing Data After
the Original Study Was Published
YEAR
200120001999199819971996
MeanPart1score
230
225
220
21...
Conclusions
• Small programs that were exhibiting a
downward trend in Part I scores, and
contributed data to the first stu...
YEAR
200120001999199819971996
Mean
20
18
16
14
12
10
PROGSIZE
4 or fewer residents
5 or more residents
Means of Square Roo...
YEAR
200120001999199819971996
Mean
26
24
22
20
18
16
14
PROGSIZE
4 or fewer residents
5 or more residents
Means of Square ...
YEAR
200120001999199819971996
Mean
3.0
2.9
2.8
2.7
2.6
2.5
2.4
2.3
2.2
2.1
2.0
PROGSIZE
4 or fewer residents
5 or more res...
YEAR
200120001999199819971996
MeanPartIScore
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more residents...
YEAR
200120001999199819971996
Meanpart1score
240
235
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more r...
YEAR
200120001999199819971996
MeanPartIScore
240
235
230
225
220
215
210
205
200
PROGSIZE
4 or fewer residents
5 or more r...
Private
282
725
1,007
216
222
0 – 4
> 5
University
213
212
2120 – 4
Hybrid
42
263
223> 5
2212130 – 4
No.
of Residents
Mean...
No. of Residents
131210987654321
AdjustedMeanPartIScore 240
230
220
210
200
Mean Part I Score vs. Program Size
Adjusted fo...
YEAR
200120001999199819971996
PercentageAOA
.5
.4
.3
.2
.1
0.0
Percentage of All Matched
Categorical Residents Who Are AOA
YEAR
200120001999199819971996
PercentageAOA
.5
.4
.3
.2
.1
0.0
PROGSIZE
4 or fewer residents
5 or more residents
Percentag...
YEAR
200120001999199819971996
Percentage
.5
.4
.3
.2
.1
0.0
Percentage of First Matched
Residents Who Are AOA
YEAR
200120001999199819971996
Percentage
.50
.40
.30
.20
.10
0.00
Percentage of Last Matched
Residents Who Are AOA
YEAR
200120001999199819971996
Medianrank 20
15
10
5
0
Median Rank List Position of All
Residents Matched (p= .000)
YEAR
200120001999199819971996
Medranklistposition
30
25
20
15
10
5
0
PROGSIZE
4 or fewer residents
5 or more residents
Med...
YEAR
200120001999199819971996
Medianrank
5.0
4.0
3.0
2.0
1.0
0.0
Median Rank List Position
of First Resident Matched
YEAR
200120001999199819971996
Medianrank
25
20
15
10
5
0
Median Rank List Position
of Last Resident Matched
YEAR
200120001999199819971996
Medianrank
40
30
20
10
0
PROGSIZE
4 or fewer residents
(p = .12)
5 or more residents
(p = .0...
The overall quality of medical students applying
for a surgical residency has declined over the last
six years.
Mean 2.7 –...
The number of medical students wishing to go
into general surgery has declined over the last
six years.
Mean 3.4 – Agree (...
Activities of medical schools and medical school
deans to encourage medical students to go into
family practice or primary...
Conclusions
• The USMLE Part I Scores are increasing
over time
• The % of our PGY-1’s who are AOA is
declining
• Big progr...
Conclusions
• The applicant pool may be shrinking
• General surgery is not as competitive a
residency to obtain as some ot...
Conclusions
U.S. Surgical Residency Program Directors do
not think that the quality of their categorical
PGY-1 residents h...
Conclusions
• The popularity of general surgery as a
specialty is declining
– Increase in unfilled categorical PGY-1 spots...
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Results of the 2001 Match:

  1. 1. Results of the 2001 Match: A Shot Across the Bow? Joseph B. Cofer, MD, FACS Professor of Surgery Program Director University of Tennessee College of Medicine Chattanooga Unit Department of Surgery Chattanooga, Tennessee
  2. 2. • Applications to the nation’s medical schools fell 3.7% in 2000 in the fourth straight year of decline • The decline was 6% in 1999 • The applicant / acceptance ratio has dropped from 2.7 in 1995 to 2.1 in 2000 Barzansky, JAMA, 286:9,2001
  3. 3. Women constituted 43% of U.S. graduates in 2001 (up from 42.6% in 2000) and 46% of total first year enrollment (up from 45.8% in 2000) Barzansky, JAMA, 286:9, 2001
  4. 4. Nursing Vacancy Rate University of Cincinnati Hospital > 20% Erlanger Hospital, Chattanooga, TN 8.6% Estimated National Rate 11-20% Fischer, Bulletin, ACOS, 86:8, 2001 Personal Communication
  5. 5. The average age of a registered nurse in the U.S. in March 2000 was 45.6 years. Associated Press, Sept. 9, 2001
  6. 6. “If current trends continue, the nation will face a shortage of half a million nurses by 2020. The nursing shortage in our country is increasing, and it places our system of medical care at risk.” Secretary Tommy Thompson, Health and Human Services, Sept. 28 , 2001
  7. 7. • Decreasing medical school applications • Changing demography of applicants • Nursing shortage • Shortage of ancillary personnel • Early retirement of physicians • Surgeons refusing to take call • Diverse societal issues Fischer, Bulletin, ACOS, 86:2001
  8. 8. “There is a freight train headed down the track and it’s pointed directly at the fragments of what previously was a good to excellent medical system” Fischer, Bulletin, ACOS, 86:2001
  9. 9. Conclusions The environment has changed! – Worsening nursing shortage – Decreasing medical school applicant pool – Increasing relative numbers of female medical students – Societal issues
  10. 10. U.S. Seniors Matched to PGY-1 General Surgery 891 928 915 890 883 853 840 874 820 760 780 800 820 840 860 880 900 920 940 1993 1994 1995 1996 1997 1998 1999 2000 2001 PGY-1 General Surgery
  11. 11. 57 45 39 31 35 55 55 73 92 0 10 20 30 40 50 60 70 80 90 100 1993 1994 1995 1996 1997 1998 1999 2000 2001 PGY-1 General Surgery Foreign Trained Physicians Matched to PGY-1 General Surgery
  12. 12. Number of Programs Ranked by U.S. Senior Students to Obtain a Categorical PGY-1 Position in the Match (Total Applicants Including FMG’s) 1996 1997 1998 1999 2000 2001 11.2 10.9 9.6 9.6 9.1 8.2 (13.8) (13.5) (11.7) (11.7) (11.0) (9.9)
  13. 13. Match Results for U.S. Seniors Who Choose One Type of Specialty (General Surgery) Students Matched Students Unmatched Ttl Students -Gen Surgery Only % By Specialty % Unmatched 2001 1063 50 1113 9.0 4.5 2000 1125 89 1214 9.7 7.3 1999 1120 97 1217 9.4 8.0 1998 1109 88 1197 9.3 7.4 1997 1156 202 1358 10.5 14.9 1996 1185 272 1457 11.2 18.7 1995 1209 258 1467 10.3 21.3
  14. 14. Ratio of U.S. Applicants Choosing a Specialty with the Number of Categorical Positions Available in that Specialty – 2001 Match 0.1Radiology – Diagnostic1.8Family Practice Psychiatry Internal Medicine General Surgery Preventive Med /Public Health Neurology Pathology 1.5 1.5 1.5 1.7 2.0 2.0 0.8Orthopaedic Surgery 0.6Physical Medicine 0.5Anesthesiology 0.5Plastic Surgery 0.1Radiation – Oncology 0.1Dermatology
  15. 15. Positions Ranked and Filled in 2001 by U.S. Senior Students No. Ranks / Position No. Ranks / Position 8.2 10.4 10.6 11.2 11.8 13.3 Internal Medicine Anesthesia Psychiatry Family Practice Pathology Neurosurgery 4.7General Surgery 4.6Plastic Surgery 3.8Orthopaedic Surgery 3.2Radiation – Oncology 2.2Dermatology 0.8Radiology – Diagnostic
  16. 16. Old vs. New Study • Original study (1996 – 1999) – 90 programs (1,312 residents) Am J Surg 181(44);2001 • New study (1996 – 2001) – 49 programs (of original 90) – 17 programs (new additions) 66 total programs (1,556 residents)
  17. 17. Total Residents in Study (% of Residents Matched That Year) 1996 1997 1998 1999 2000 2001 Old Study 305 (30.4) 323 (32.0) 337 (32.9) 347 (34.3) — — New Study 251 (25.0) 252 (25.0) 253 (24.7) 262 (26.0) 266 (26.0) 272 (28.0)
  18. 18. 230 YEAR 1999199819971996 MeanPart1score 225 220 215 210 205 200 PROGSIZE 4 or fewer residents 5 or more residents Programs In Original Sample Providing 6 Years of Data
  19. 19. Programs From Original Sample Not Providing 6 Years of Data YEAR 1999199819971996 MeanPart1score 230 225 220 215 210 205 200 PROGSIZE 4 or fewer residents 5 or more residents
  20. 20. Programs Providing Data After the Original Study Was Published YEAR 200120001999199819971996 MeanPart1score 230 225 220 215 210 205 200 PROGSIZE 4 or fewer residents 5 or more residents
  21. 21. Conclusions • Small programs that were exhibiting a downward trend in Part I scores, and contributed data to the first study, did not contribute to the second study • Small programs that were exhibiting an upward trend in Part I scores and who had not contributed data to the first study, added their 6 years of data to the second study • Was this a Hiesenberg effect?
  22. 22. YEAR 200120001999199819971996 Mean 20 18 16 14 12 10 PROGSIZE 4 or fewer residents 5 or more residents Means of Square Root of Total Number of Surgical Applicants From U.S. Medical Schools
  23. 23. YEAR 200120001999199819971996 Mean 26 24 22 20 18 16 14 PROGSIZE 4 or fewer residents 5 or more residents Means of Square Root of Total Number of Applicants to U.S. Surgery Programs (U.S. + Foreign)
  24. 24. YEAR 200120001999199819971996 Mean 3.0 2.9 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 2.0 PROGSIZE 4 or fewer residents 5 or more residents Analysis of Square Root of the Ratio of Applicants to Interviews Granted
  25. 25. YEAR 200120001999199819971996 MeanPartIScore 230 225 220 215 210 205 200 PROGSIZE 4 or fewer residents 5 or more residents Mean Part I Scores of All Residents
  26. 26. YEAR 200120001999199819971996 Meanpart1score 240 235 230 225 220 215 210 205 200 PROGSIZE 4 or fewer residents 5 or more residents Mean of Part I Scores of First Resident Matched
  27. 27. YEAR 200120001999199819971996 MeanPartIScore 240 235 230 225 220 215 210 205 200 PROGSIZE 4 or fewer residents 5 or more residents Means of Part I Scores of Last Resident Matched
  28. 28. Private 282 725 1,007 216 222 0 – 4 > 5 University 213 212 2120 – 4 Hybrid 42 263 223> 5 2212130 – 4 No. of Residents Mean Part I Board Scores No. of Categorical PGY-1 Spots
  29. 29. No. of Residents 131210987654321 AdjustedMeanPartIScore 240 230 220 210 200 Mean Part I Score vs. Program Size Adjusted for Differences Between Years
  30. 30. YEAR 200120001999199819971996 PercentageAOA .5 .4 .3 .2 .1 0.0 Percentage of All Matched Categorical Residents Who Are AOA
  31. 31. YEAR 200120001999199819971996 PercentageAOA .5 .4 .3 .2 .1 0.0 PROGSIZE 4 or fewer residents 5 or more residents Percentage of All Matched Categorical Residents Who Are AOA by Program Size
  32. 32. YEAR 200120001999199819971996 Percentage .5 .4 .3 .2 .1 0.0 Percentage of First Matched Residents Who Are AOA
  33. 33. YEAR 200120001999199819971996 Percentage .50 .40 .30 .20 .10 0.00 Percentage of Last Matched Residents Who Are AOA
  34. 34. YEAR 200120001999199819971996 Medianrank 20 15 10 5 0 Median Rank List Position of All Residents Matched (p= .000)
  35. 35. YEAR 200120001999199819971996 Medranklistposition 30 25 20 15 10 5 0 PROGSIZE 4 or fewer residents 5 or more residents Median Rank List Position of Matched Residents by Program Size
  36. 36. YEAR 200120001999199819971996 Medianrank 5.0 4.0 3.0 2.0 1.0 0.0 Median Rank List Position of First Resident Matched
  37. 37. YEAR 200120001999199819971996 Medianrank 25 20 15 10 5 0 Median Rank List Position of Last Resident Matched
  38. 38. YEAR 200120001999199819971996 Medianrank 40 30 20 10 0 PROGSIZE 4 or fewer residents (p = .12) 5 or more residents (p = .003) Median Rank of Last Resident Matched by Program Size
  39. 39. The overall quality of medical students applying for a surgical residency has declined over the last six years. Mean 2.7 – Disagree (P=.04)
  40. 40. The number of medical students wishing to go into general surgery has declined over the last six years. Mean 3.4 – Agree (P=.01)
  41. 41. Activities of medical schools and medical school deans to encourage medical students to go into family practice or primary care has hurt recruitment for general surgery residents. Mean 3.6 – Agree (P=.000)
  42. 42. Conclusions • The USMLE Part I Scores are increasing over time • The % of our PGY-1’s who are AOA is declining • Big programs attract residents with higher board scores
  43. 43. Conclusions • The applicant pool may be shrinking • General surgery is not as competitive a residency to obtain as some other more lucrative and less rigorous careers in medicine • Decreasing numbers of FMG’s applying, but more matching • Going deeper into the rank list to fill
  44. 44. Conclusions U.S. Surgical Residency Program Directors do not think that the quality of their categorical PGY-1 residents has declined, but they do feel that the applicant pool is shrinking, and that Medical School Deans are contributing to this decline in the desire of medical students to become surgeons.
  45. 45. Conclusions • The popularity of general surgery as a specialty is declining – Increase in unfilled categorical PGY-1 spots – Decreasing number of programs needed to rank to obtain a spot • If you are a U.S. senior medical student, there is a 95% chance you can be a surgeon if you want to
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