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For Match Day today, Baily Nagle, vice president of her graduating class at Harvard Medical School, will be celebrating “the luck of the Irish” on St. Patrick’s Day that allowed her to match into her chosen specialty and top choice of residency programs: anesthesia at Brigham and Women’s Hospital.
“I am feeling very excited and relieved – I matched,” she told Medscape Medical News upon hearing her good fortune on Match Monday. She had a similar reaction today. “After a lot of long nights and hard work, happy to have it pay off,” she shared with Medscape Medical News after a phone call amid raucous festivities.
Nagle’s immediate plans call for celebrating tonight at a school-sponsored party and a private bar crawl of the nearby Fenway Park area of Boston with friends.
Nagle was so determined to match into her specialty that she didn’t have any other specialties in mind as a backup.
The annual process of matching medical school graduates with compatible residency programs is an emotional rollercoaster for all applicants, their personal March Madness, communication at exelon corporation so to speak. But Nagle was one of the more fortunate applicants. She didn’t have to confront the heartbreak other applicants felt when the National Resident Matching Program (NRMP) announced results this week of the main residency match and the Supplemental Offer and Acceptance Program (SOAP), which offers alternate programs for unfilled positions or unmatched applicants.
During this year’s Match process, Medscape Medical News has been following a handful of students, checking in with them periodically for updates on their progress. Most of them matched successfully, but at least one international medical graduate (IMG) did not. What the others have in common is that their hearts were set on a chosen specialty. Like Nagle, another student banked on landing his chosen specialty without a backup plan, whereas another said that she’d continue through the SOAP if she didn’t match successfully.
Overall, Match Day resulted in a record number of residency positions offered, most notably in primary care, which “hit an all-time high,” according to NRMP President and CEO Donna L. Lamb, DHSc, MBA, BSN. The number of positions has “consistently increased over the past 5 years, and most importantly the fill rate for primary care has remained steady,” Lamb noted in the NRMP release of Match Day results. The release coincided with students learning through emails at noon Eastern Time to which residency or supplemental programs they were matched.
Though more applicants registered for the Match this year than in 2022 — driven primarily by non-US IMGs — the NRMP stated that it was surprised by the decrease in US MD senior applicants.
US MD seniors had a nearly 94% Match rate, a small increase over last year. US citizen IMGs saw a nearly 68% Match rate, which NRMP reported as an “all-time high” and about six percentage points over last year, whereas non-US IMGs had a nearly 60% Match rate, a 1.3 percentage point over 2022.
Among the specialties that filled all available positions this year were orthopedic surgery, plastic surgery (integrated), and radiology — diagnostic and thoracis surgery.
Not Everyone Matches
Earlier this week, the American College of Emergency Physicians issued a joint statement with other emergency medicine (EM) organizations about a high rate of unfilled EM positions expected this year.
NRMP acknowledged today that 554 positions remained unfilled, an increase of 335 more unfilled positions than last year. NRMP attributed the increase in unfilled positions in part to a decrease in the number of US MD and US DO seniors who submitted ranks for the specialty, which “could reflect changing applicant interests or projections about workforce opportunities post residency.”
Applicants who didn’t match usually try to obtain an unfilled position through SOAP. This year, 2685 positions were unfilled after the matching algorithm was processed, an increase of nearly 19% over past year. The vast majority of those positions were placed in SOAP, an increase of 17.5% over past year.
Asim Ansari was one of the unlucky ones. As Medscape Medical News reported last week, Ansari was trying to match for the fifth time. He was unsuccessful in doing so again this year in the Match and SOAP. Still, he was offered and accepted a child and adolescent psychiatry fellowship at Kansas University Medical Center in Kansas City. Psychiatry was his chosen specialty, so he was “feeling good. It’s a nice place to go to do the next two years.”
Ansari, who started the #MatchMadness support group for unmatched doctors on Twitter Spaces, was quick to cheer on his fellow matching peers on Match Monday while revealing his own fate: “Congratulations to everyone who matched!!! Y’all are amazing. So proud of each one of you!!! I didn’t.”
Soon after Monday’s results, #MatchMadness held a #Soap2023 support session, and Ansari sought advice for those willing to review SOAP applications. Elsewhere on Twitter Match Day threads, a few doctors offered their support to those who planned to SOAP, students announced their matches, and others either congratulated or encouraged those still trying to match.
Not everyone who matched considered the alternative. Before Match Monday, William Boyer said that he hadn’t given much thought to what would happen if he didn’t match because he was “optimistically confident” he would match into his chosen EM specialty. But he did and got his top choice of programs: Yale New Haven Hospital.
“I feel great,” he told Medscape about the match. “I was definitely nervous opening the envelope” that revealed his residency program, “but there was a rush of relief” when he saw he landed Yale.
Earlier in the match cycle, he told Medscape Medical News that he “interviewed at a few ‘reach’ programs, so I hope I don’t match lower than expected on my rank list.”
Boyer considers himself “a mature applicant,” entering the University of South Carolina School of Medicine after 4 years as an insurance broker.
“I am celebrating today by playing pickleball with a few close medical friends who also matched this morning,” Boyer said on Match Monday. “I definitely had periods of nervousness leading up to this morning though that quickly turned into joy and relief” after learning he matched.
Boyer believes that his professional experience in the insurance industry and healthcare lobbying efforts with the National Association of Health Underwriters set him apart from other applicants.
“I changed careers to pursue this aspiration, which demonstrates my full dedication to the medical profession.”
He applied to 48 programs and was offered interviews to nearly half. Boyer visited the majority of those virtually. He said he targeted programs close to where his and his partner’s families are located: Massachusetts, North Carolina, and Texas. “My partner, who I met in medical school, matched into ortho as well so the whole household is very happy,” Boyer shared Monday.
She matched into her top choice as well today, though a distance away at UT Health in San Antonio, Texas, he said. “We are both ecstatic. We both got our no. 1 choice. That was the plan going into it. We will make it work. I have 4 weeks of vacation.”
In his program choices, Boyer prioritized access to nature, minimal leadership turnover, a mix of clinical training sites, and adequate elective rotations and fellowship opportunities, such as in wilderness medicine and health policy.
NRMP reported that there were 1239 couples participating in the Match; 1095 had both partners match and 114 had one partner match to residency training programs for a match rate of 93%.
Like Boyer, Hannah Hedriana matched into EM, one of the more popular despite the reported unfilled positions. In the past few years, it has consistently been one of the fastest-growing specialties, according to the NRMP.
Still Hedriana had a fallback plan. “If I don’t match, then I do plan on going through SOAP. With the number of EM spots that were unfilled last year, there’s a chance I could still be an EM physician, but if not, then that’s okay with me.”
Her reaction on Match Monday, after learning she matched? “Super excited, celebrating with my friends right now.” On Match Day, she said she was “ecstatic” to be matched into Lakeland Regional Health in Lakeland, Florida. “This was my first choice so now I can stay close to family and friends,” she told Medscape Medical News soon after the results were released.
A first-generation, Filipino-American student from the University of South Florida College of Medicine, Hedriana comes from a family of healthcare professionals. Her father is a respiratory therapist turned physical therapist; her mother a registered nurse. Her sister is a patient care technician applying to nursing school.
Hedriana applied to 70 programs and interviewed mostly online with 24. Her goal was to stay on the East Coast.
“My partner is a licensed dentist in the state of Florida, and so for his career it would be more practical to stay in-state, rather than get relicensed in another state, which could take months,” she said earlier in the matching cycle. “However, when we discussed choosing a residency program, he ultimately left it up to me and wanted me to pick where I thought I’d flourish best,” Hedriana said, adding that her family lives in Florida too.
She said she sought a residency program that values family and teamwork.
“A program gets more points in my book if they have sites at nonprofit hospitals or has residents that regularly volunteer throughout their communities or participate in DEI [diversity, equity, and inclusion] initiatives.”
Hedriana noted that some specialties exclusively offered virtual interviews this year, whereas other specialties favored in-person interviews. “This year, many of my classmates were able to do multiple away rotations, which they saw as a positive regarding their chances of matching.” During COVID, in-person visits were limited.
“However, I’ve noticed that many of my classmates are not fond of the signaling aspect that was present for this year’s cycle.” Signaling is a relatively new process that allows applicants to indicate interest in a limited number of residency programs. Not all residencies participate, but it’s growing in popularity among specialties, according to the American Medical Association.
Nagle, a second lieutenant in the US Air Force, applied to 12 programs and interviewed with half of them online. She said that she wasn’t targeting any specific type of program through the match.
“I believe you can get phenomenal training anywhere where you mesh with the residents and leadership. My ultimate priority is to (1) be near good people, (2) be near good food (Indian and Thai are a must), and (3) be near an international airport so I can flee the country during breaks.”
Meanwhile, she said that she found the application process, in which students have to articulate their entire medical school experience, extremely competitive. “I think this process is so easy to get wound up in and the anxiety can be palpable,” Nagle said. “People around you match your energy. So if you are a ball of anxiety then so are your attendings and residents –– and that doesn’t bode well for passing the ‘do I want to be on call with them’ test.”
Looking back at medical school, Baily Nagle recalled having a baby named after her during her first anesthesia rotation and being featured on The Kelly Clarkson Show. Nagle said that she had walked into the delivery room where new parents had been debating names of babies beginning with the letter B. “And when I introduced myself, they looked at each other and said, ‘Yep, that’s the one.'”
Boyer recounted how the majority of his medical school experience involved online education. “Roughly two-thirds of my first year was in-person prior to the pandemic. However, from spring break first year to in-person clinical rotations at the beginning of third year, we were all virtual. While I missed interacting with my classmates, I benefited from the virtual learning environment as I learn more efficiently from reading and visual aids than auditory lectures.”
Hedriana cited the friends and memories she made while learning to be a doctor. “Medical school was hard, but I wouldn’t have changed a thing.”
Roni Robbins is an editor/writer for Medscape Business of Medicine. She’s been published in WebMD, HuffPost, Forbes, NY Daily News, BioPharma Dive, MNN, Adweek, Healthline, and others. She’s also the author of Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune, www.ronirobbins.com.
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