It’s Match Day 2017 — good luck today! We hope you read and followed our advice from August (in the blog post below) and are matched to the best program for you.
It’s an emotional time, and you’re likely to remember your Match Day for the rest of your career. Two NEJM Knowledge+ consultants share recollections of their own Match Days:
I remember being incredibly relieved that I received my top pick for general surgery, but also feeling very sad for my close friends who did not receive their top picks. For some of my friends it meant that they were now going to be long-distant for at least a year until one could transfer programs. The whole day was a blur of celebrating with the ones who were happy and consoling the ones who were disappointed.
—Roy Phitayakorn, MD, MHPE (MEd), FACS; General and Endocrine Surgery Director, Office of Surgery Education Research, The Massachusetts General Hospital; Senior Education Research and Development Consultant, NEJM Group
I was a resident in Ireland on Match Day. After spending all my vacation time interviewing, I was back on a medicine team and I was on call on Match Day! At the time that the results were made official, I was admitting a patient from the emergency department. Luckily, the patient wasn’t too sick, so I could leave her to go log on to the website. I was refreshing it every 10 seconds until the results came through… and I found that I had matched at my number one program! I definitely shouted and danced a little – which the ED staff either found entertaining or annoying, I am not sure. After sending off a few text messages, it was back to admitting patients. I think I admitted seven patients that night, so I didn’t really have a chance to savor the results until the day after.
—Ole-Petter Riksfjord Hamnvik, MB, BCh, BAO, MMSc; Endocrinologist at Brigham and Women’s Hospital; Associate Program Director, Endocrinology Fellowship and Assistant Program Director, IM residency, at BWH; Senior Consulting Education Editor, NEJM Knowledge+
From August 2016:
With internal medicine residency interview season starting soon, it’s a good time to formulate a personal decision model – one that will determine which questions to ask during interviews and tours, and how to weigh various factors and rank options for The Match.
Although the competitiveness of residency matching is increasing overall in the United States — that is, the total number of medical school graduates seeking residency positions is growing more rapidly than the number of residency positions — the field for internal medicine among U.S. medical school seniors (allopathic) appears to have become slightly less competitive over recent years. According to National Resident Matching Program, Results and Data: 2016 Main Residency Match® (National Resident Matching Program, Washington, DC):
“Internal medicine (categorical) gained positions every year in the past five years, from 5,227 in 2012 to 7,024 in 2016, an increase of 1,747 or 33.1 percent. The overall position fill rate is high at 98.8, but only 46.9 percent were filled by U.S. seniors, the lowest on record since 1978.”
Of U.S. seniors (allopathic) seeking categorical internal medicine residencies, some 84.7% matched in 2016. For all other applicants (previous U.S. graduates with a graduation date before July 1 in the year before the Match, graduates of Osteopathic medical schools, U.S. and non-U.S. citizens graduating from foreign medical schools), the match rate for internal medicine in 2016 was 46.5%.
Here is an aggregation of other key statistics for internal medicine residency programs:
|Number of internal medicine residency programs||444|
|Number of internal medicine residency positions offered||7,024|
|Number/percent filled in Match||6,938/98.8%|
|Total number of applications/matches/match rate for IM||11,733/6,938/59.1%|
|– Applications/matches/match rate – US seniors (allopathic)||3,885/3,291/84.7%|
|– Applications/matches/match rate – All others||6,938/3,647/46.5%|
|Program fill rate – US seniors (allopathic)||46.9%|
|Program fill rate – All||98.8%|
|Percent of all U.S. seniors (allopathic) obtaining residency positions in Internal Medicine (categorical)||19.3%|
Match stats for IM from 2014 (Charting Outcomes in the Match, 2014, National Resident Matching Program, Washington, DC) show even higher rates of matching for U.S. seniors when internal medicine is ranked exclusively. Indeed:
- 98% of U.S. seniors who ranked IM exclusively matched to IM programs (n=3,210).
- 84% who ranked IM and one other specialty matched to IM programs (n=172).
- 71% who ranked IM and two other specialties matched to IM programs (n=21).
Assessing Where You Stand
To determine who they will interview this fall, internal medicine residency programs will filter applications on a broad variety of criteria, including (but not limited to):
- Performance/class rank in medical school
- USLME Step 1 and Step 2 scores
- Research, work, and volunteer experiences
- Honors work
- Alpha Omega Alpha (AOA) membership
- Medical school rank/prestige
Summary stats for internal medicine matches (2014) can be found on page 110 of this report. The American Medical Association’s FREIDA Online® is a one-stop shop for gauging, based on many of the above criteria, one’s chances of landing interviews with specific internal medicine residency programs.
Although application filtering is certainly not etched in stone, taking the time to research and understand where one fits competitively in the field will assist in creating a ranking for The Match that is well balanced in terms of reach, likely, and safety options. It will also help minimize the cost associated with applying and traveling for interviews with various internal medicine residency programs.
In deciding where to apply and interview, internal medicine residency hopefuls are also strongly advised to research their own medical school’s statistics and recent histories with various programs, which can help to reveal subtle program biases either for or against specific schools.
The program prestige factor
Beyond FREIDA Online®, the doximity Residency Navigator, in partnership with U.S. News and World Report, is a common early stop for soon-to-be medical school graduates working on their short lists of targets for internal medicine residency applications.
This program ranking system — while valuable for aggregating many programs’ statistics into a single, easy-to-navigate-and-compare format — also engenders an idea that there are clear ‘tiers’ of internal medicine residency programs. Student forums on the subject, for example, are rife with references to Top 10, Top 25, Top 30 programs, and so forth.
With 444 internal medicine residency programs in all, it is safe to assume there are many excellent programs that fall outside the so-called top tiers and will be, for many students, far better fits for various reasons. The residency interview process is your chance to dig deep beneath the surface rankings to figure all this out.
Finding the right program for you
Assuming you’re a U.S. medical school senior, have set your sights on internal medicine as a first choice, and have made a realistic assessment of probabilities for matching to specific programs, the interview process is also where the balance of power begins to shift in your favor. While you certainly will be selling yourself to program directors and others, internal medicine residency programs will also be working to sell themselves to you.
While a complete list of factors to consider falls beyond the scope of this post, we focus here on key areas and provide a set of aggregated links to useful follow-up resources:
Educational rigor and value
The number one factor for balancing program rank or prestige is educational rigor and value. This includes everything from program accreditation and philosophy to rotations, rounds, conferences and seminars, faculty dedication to teaching (as opposed to research and other professional obligations), elective opportunities, exposure to subspecialties, variety of clinical settings, libraries, and other resources for residents. To assess a program’s educational rigor and value, some questions to ask in interviews and on tours include:
- What is the faculty-to-student ratio, how dedicated are faculty to teaching, and what competing research and other professional commitments do faculty have?
- What is to be expected in terms of patient complexity, acuity, racial/ethnic, geographic, age, wealth, and other forms of diversity?
- What are typical outcomes for program graduates – for example, eventual practice settings, number/percentage pursuing and matching to desired fellowships, and practice settings, and first-time certification board pass rates?
While program administrators and current residents will provide their own perspectives on these and other questions, applicants are also strongly encouraged to seek conversations with recent program graduates who have less motivation to try to sell the program to you.
Beyond education rigor and value lie all the operational aspects of internal medicine residency programs. Key structural information to uncover in interviews includes team composition, call schedules, procedures, and time allocation (education versus ‘scut’ work).
It’s also important to assess quality and routine interaction with house staff and to learn what opportunities there will be for collaborating with various other clinicians such as PAs, NPs, pharmacists, and mental health professionals.
Finally, in the area of program structure, be sure to find out how an internal medicine residency program fits into the larger structure of a hospital or hospital system. For example, will there be competition for patients and procedures from other programs such as Family Medicine? And how do internal medicine residents typically interact with residents participating in other specialty programs?
The third major area to assess thoroughly through residency interviews is the potential for personal happiness, inclusive of partners and family. Will the location be socially and culturally fulfilling? Assuming standard rigors of medical residency, will there be sufficient work-life balance? What will the commute be like? Is the salary in line with the local cost of living?
Ranking Your Options
In ranking internal medicine residency programs for the Match, a few recommendations are common. Be sure to rank:
- Every program you would be willing to join
- Sufficient numbers of programs
- In order of your true preference — and not by your own assessment of where you think you can match
If you’re ranking more than one specialty, pay attention to contiguous ranking — the number of programs ranked in the first-choice specialty before a program in another specialty appears in your rank order list. Detailed Match data from 2014 clearly suggest the probability of matching in internal medicine is higher when larger numbers of IM programs are ranked contiguously:
|Internal Medicine, 2014||US Seniors||Independent applicants|
|Mean number of contiguous ranks||11.2||4.0||7.0||2.4|
|Mean number of distinct specialties ranked||1.1||1.4||1.3||1.4|
Finally, as the Match is a contractually binding process, never rank a program you definitely do not want. If, as in rare cases, you don’t match, you may still be able to scramble into a program that was low on your ranked list through the Supplemental Offer and Acceptance Program® (SOAP®).
Additional key resources for evaluating internal medicine residency programs
Applying and ranking the right internal medicine residency program is an extraordinarily high pressure and complex process. To make things just a bit easier, we aggregate here some links to other resources that might help:
- Commonly asked Residency Interview Questions (American College of Physicians)
- Don’t Forget to Ask: Advice from Residents on What to Ask During the Residency Interview (Association of American Medical Colleges)
- NRMP Applicant Survey Results 2015 (see page 54 for how IM residents ranked various program decision factors)
- ABIM Pass Rates by Residency Program (2013-2015)
Best of luck to all internal medicine residency hopefuls in the coming application, interview, and Match season! If you have been through the internal medicine residency Match process and have advice to offer, please do so in the comments section below.