“You are not a failure. It’s a failure of the system.”


year to do research or clinical work to strengthen his application.


The longer students wait, however,


the lower their chances of matching, As- sociation of American Medical Colleges (AAMC) data show. (See “Missed Oppor- tunities,” page 50.) Fewer available SOAP slots are a big factor contributing to the nonmatch numbers, but not the only one, educa- tors say. The problem can compound when students who don’t match jump into the following year’s pool of residen- cy candidates. Even so, “if 100 students don’t match


experiencing rapid growth in population and prevalence of chronic illnesses. To keep pace, the Texas Medical Asso- ciation and organized medicine continue to advocate at the state and national lev- els for increased funding for additional graduate medical education (GME) training spots. (See “Reconsidering GME Funding,” pages 53–54.)


But medical education leaders also point to an increasingly competitive match climate as part of the problem, as they search for ways to better counsel students to maximize their opportunities early and often throughout their medical education. The TMA Ad Hoc Council of Medical School Deans raised the issue at TexMed 2014. “To have any students who don’t have a place to continue to train is an issue, considering all the money we put into medical education,” said Steven L. Berk, MD. The dean of the Texas Tech Univer- sity Health Sciences Center (TTUHSC) School of Medicine in Lubbock chairs the TMA deans group and serves as a consultant to the association’s Council on Medical Education. “Schools have al- ways had the infrastructure for advising students. But so much has changed that what we used to tell students three or four years ago is not the same thing we should tell them now to advise well and maximize their chances for success.”


Competition heats up Nationally, 16,000 U.S. medical school seniors — 94 percent — matched to a first-year residency position in 2014, ac- cording to NRMP (www.nrmp.org/2014-


48 TEXAS MEDICINE September 2014


nrmp-main-residency-match-results). Half matched to their first choice, and roughly 80 percent matched to one of their top-three choices. This year’s match also offered 500 more positions — mostly in primary care — than in 2013, for a total of more than 29,000 first- and second-year slots. Despite those gains, 2013 was the first year there were more unmatched seniors (1,097) in the post-match SOAP program than open first-year po- sitions (850) — a trend TMA leaders warn could worsen as medical schools graduate more students. In 2014, the gap shrunk but remained with 975 un- matched seniors and 934 unfilled first- year positions. Of those, 412 did not match at all. A TMA survey of Texas’ nine medical schools shows that out of 100 fourth- year Texas medical students who did not match to a residency program during the 2014 main match, 68 found a position during the post-match process. Thirty- two did not match at all — 2 percent of this year’s roughly 1,600 medical school graduates.


The most competitive specialties for


Texas students were orthopedic surgery, surgery, otolaryngology, dermatology, obstetrics-gynecology, and ophthalmol- ogy, according to TMA’s survey. National data show similar results. A handful of Texas students who did not match right away chose not to par- ticipate in SOAP and instead pursued other options, such as a master’s degree, according to TMA’s survey. Dr. Novo says he considered taking a transitional


in Texas, additional GME slots sounds like a fantastic thing. But it depends on the [specialty] distribution,” of those added slots, said Dr. Berk, an internist who specializes in geriatrics and infec- tious diseases. “Lots of things happen in four years of medical school that influ- ence students’ interests. They develop competitive records, and suddenly they never thought about dermatology until they get a 270 on the USMLE.” Dr. Novo adds that market and life- style factors, such as practice location, ability to pay off student loans, and de- mand for certain specialties, also influ- enced his decisionmaking. Fewer open positions in the supple-


mental match make for a more competi- tive environment, with more students applying to more programs across a broad range of specialties to better their chances.


And the match process itself has changed, Dr. Berk adds, with some ben- efits and drawbacks. As of 2012, SOAP replaced the previ- ously unmanaged “post-match scramble,” which left students and schools on their own scrambling to line up interviews and applications for as many unfilled spots as possible. That also put pressure on residency programs flooded with requests. Now, NRMP simultaneously releases information on unmatched ap- plicants and programs, and it’s up to res- idency programs to reach out to students with offers.


But students have just two hours to accept or reject those offers between rounds — usually with no interviews — giving what educators described in


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