Next March, medical students across the country will again open envelopes disclosing where, and whether, they matched with residency. The stakes are high: Without residency, these students cannot practice as doctors.
A major driver of this anxiety is the so-called residency shortage. This leaves thousands of capable medical school students unmatched. According to commonly cited match data, only 80% of applicants match to a residency position. These data appear appalling. Without a residency match, medical students fear finding themselves in six-figure debt with no pathway to practice. Fortunately, a reexamination of match data bears surprising news: There is no residency shortage.
There are a few reasons for this prevailing misconception. Most important is that initial residency-match numbers don’t account for the Supplemental Offer and Acceptance Program, or SOAP — a period following Match Day in which unmatched students are connected with open positions. After SOAP, match rates for American medical students jump to 99%.
Variance in competitiveness between specialties contributes as well. While competitive, high-salary fields like dermatology match only 10%-15% of applicants, broader fields like family medicine match at high rates. In fact, 10% of these residency positions go unfilled. SOAP corrects this by allowing those who didn’t match in a competitive field to try a different one.
International medical school graduates inflate the number of failed matches. Typically, only top-tier graduates in this category can break into American residency programs and mainly match into high-need areas like family medicine. Match rates here hover around 60%, skewing overall match data.
To be clear: There is a surplus of residency positions for U.S. graduates, but that doesn’t mean the United States doesn’t need more residencies. Given the rate that medical schools are increasing class sizes, and the severity of the physician shortage, we must continue increasing residency quantities to maintain this balance. There are three major takeaways.
First, if you’re a medical student applying to residency this fall, take a deep breath. Your odds are better than you might think.
Second, states increasingly pursue programs like Assistant Physicians as alternative pathways for unmatched graduates to practice lower-level medicine. Although well-intentioned, states should examine the data closely before they invest. Missouri created a program, but, according to a 2017 study, only 25 graduates entered practice as APs. All came from international schools, and only 42% passed the required clinical knowledge exams. Yet since Missouri’s flagship program, four states created similar ones.
Finally, when students still don’t match, states can hold medical schools accountable. Unlike universities and law schools, which are legally obligated to publish employment outcomes, there is no such requirement for medical schools. Students pay the price for this lack of transparency: In a 2020 survey of medical graduates, 10% felt they hadn’t learned the skills necessary for beginning residency. Students should be able to know their chances of getting a residency before applying to medical school, not years and hundreds of thousands of dollars later.
Public match data would also foster competition between medical schools competing for quality applicants. By publicizing these data, medical schools will work harder to prepare students for the match —and be held accountable when they don’t. In Texas, it’s worked: Since publicizing match data in 2014, the Texas Medical Association saw dramatic increases in match rates.
The U.S. residency supply, for the time being, is nothing to fear. But the pervasive misconception about a residency shortage is a serious concern. Clear and transparent match data from medical schools would nip confusion in the bud and push schools to train future doctors to be their best.
Kate Farmer is an Education and Healthcare Policy Fellow at the Cicero Institute.
