Tuesday, April 20, 2004

Mr Page has a response to my post about the potential changes to the 80-hour workweek limits. His analysis of the NRMP data is as follows:

But let's look at that data at little more closely. It turns out that of the 31,140 participants in the match last year, only 19,392 were matched to a PGY-1 residency. Now, it could be true that some of these doctors are so horrendously bad that not a single program wanted them. But that's probably not the case for most. A good chunk of those medical school graduates probably chose not to apply to certain residency programs. In other words, they would rather not do a residency, wait a year, and then apply again.

I am afraid that Mr. Page made an incorrect assumption. From the above I can only assume that he thinks there are almost 12,000 unmatched, unemployed physicians out there. The data in question is located in Table 2 of the PDF link above. I have reproduced it below:

Total Applicants 31,140 (100.0%)
Withdrew 3,717 (11.9%)
No Ranking 2,177 (7.0%)
Active Applicants 25,246 (100.0%)
Matched PGY-1 19,392 (76.8%)
Unmatched PGY-1 5,855 (23.2%)

Now while 31,140 people participated in the match in 2004, only 25,246 of those submitted rank lists. The reasons for those not submitting rank lists are not clear. Maybe they had to repeat part of the fourth year, failed USMLE 2, or wanted to do research. Some specialites such as ophthalomolgy also have their own match which may account for some of the withdrawals. (i.e. the applicant enrolled in the NRMP as a "backup" plan but got out when they got their other slot). I doubt the logic of "they would rather not do a residency, wait a year, and then apply again" is applicable. At least it wasn't when I was in medical school. A one-year gap in training leads to all sorts of "please provide details on a separate page" issues when filling out applications for things such as licensure, board certification, and provider panels. Another question that is not answered is how many of the 11,849 (or 5,855 if you count only the unmatched people) found positions outside the match? Not all of those that did not match were bad students. Many medical students are give bad advice on program selection or rank-list strategy, which can lead to a call to the Dean of Students office on Black Tuesday. Given the large numbers of unfilled primary care slots these people were likely to find a program to their liking. Regardless, the fact that there are so many positions that go unfilled makes it unlikely that the ACGME will allow more to be created.

Almost forgot to respond to this:

You'll notice from the NRMP data that specialties like dermatology and opthamology, known for their less strenuous lifestyle, filled every one of their residency positions. It was the surgery and internal medicine programs that left lots of open slots.

Derm and ophthamology are known for their "less strenuous lifestyle" and the desirability of such a lifestyle makes those specialites competitive. Another issue is the number of positions. According to the above data there were a total of 294 PGY 1&2 derm slots in 2004 with only 4 ophthal slots in 2004 (as stated before, they have their own match). So the numbers lend themselves to high fill rates. Even general surgery with 1,044 positions had a fill rate of 84 percent, twice that of family practice.
Weblog Commenting and Trackback by HaloScan.com

This page is powered by Blogger. Isn't yours?