Council on Medical Education Studies Ways to Improve Match Outcomes
By Sean Price


American medical school seniors from allopathic schools match to residency programs at higher rates than applicants such as osteopathic students and international medical graduates (IMGs), the Texas Medical Association’s Council on Medical Education heard during in-depth presentation on the U.S. match system at the Texas Medical Association’s Winter Conference.

The presentation was designed in part to explore ways to improve match rates for medical school students, says Marcia Collins, TMA director of medical education.

"Every unmatched U.S. medical school graduate is a loss — a loss for the physician, for the medical school, and for society, which may not benefit from that physician’s contributions to medical care," she said.

Friday's presentation also was prompted by a controversial resolution TMA's IMG Section introduced at the House of Delegates in 2018. That resolution called for TMA to repeal its current policy and endorse allowing medical school graduates who have no residency training in the United States to practice medicine in Texas under physician supervision. Delegates strongly opposed the resolution, so the IMG Section withdrew it and asked for a study of match rates for U.S. graduates instead.

A widespread belief that many American allopathic medical students are not matching to residency positions is untrue, according to Mona Signer, president and CEO of the National Resident Matching Program (pictured), the nonprofit organization that oversees the placement of physicians into residency training programs.

"There are more than enough residency positions in the United States for every [allopathic] U.S. medical school graduate," she told the Council on Medical Education. "In fact, there are 11,000 more [first-year residency] positions than there are allopathic medical school seniors."

However, the presentation, which also included a written report from TMA staff, showed that other applicants match at lower rates. The other groups include osteopathic medical school seniors and previous graduates, American IMGs (U.S. citizens attending medical school abroad, mostly in the Caribbean and Mexico), non-U.S. citizen IMGs, and American allopathic medical school graduates who previously failed to match.

In 2018, 78 percent of the approximately 44,000 applicants matched to a residency position, Ms. Signer says. Of that 78 percent, American allopathic medical school seniors had the highest match rate, at 94 percent, followed by osteopathic seniors and previous graduates (91 percent), American IMGs (57 percent), foreign IMGs (56 percent), and other American graduates, including previously unmatched American allopathic graduates (43 percent).

Applicants who do not match can enter into the Supplemental Offer and Acceptance Program (SOAP). American allopathic seniors are preferred candidates in SOAP, Ms. Signer says. Once SOAP is complete, 97 percent of American seniors from a given year have a residency position, she says. In 2018, there were more 13,176 SOAP-eligible applicants, and IMGs made up the largest single group of them, with 5,240.

Many IMGs — both U.S.-born and foreign — apply for the match in hopes of getting a residency position through SOAP, Ms. Signer says. But American seniors are overwhelmingly the preferred applicants, so that is not a sound strategy.

"SOAP is not a plan," she said. "You can't register for the match and hope that you're going to get a position through SOAP."

However, she said, it’s not unusual for IMG students to obtain positions over American allopathic medical students in the main match.

"The reality is that program directors … prefer to take a highly qualified IMG over a U.S. allopathic senior who has academic or professionalism issues," she said.

Ideas for improvement

The council also heard from three panels about ways to improve match rates. The panels provided perspectives from student affairs deans at medical schools, graduate medical education deans at medical schools, and IMG physicians.

Sejal Mehta, MD,chair of the TMA’s IMG Section Governing Council, pointed out that about one-quarter of U.S. physicians are IMGs, and that they receive rigorous medical school training, just like American students. She said on average several dozen students per year from all backgrounds do not match in Texas.

"That's a loss to our community because it takes a lot of money to train a medical student," said Dr. Mehta, who proposed the IMG’s 2018 resolution. "I know there's no simple answer to this, but this is a major problem."

Council on Medical Education members brainstormed potential ways to get more seniors and graduates matched and to prevent any avoidable non-matches. They included:

Preparing medical students for the match from the first day of medical school, providing coaching on specialty selection.

  • Providing students with adequate interview preparation, including mock interviews.
  • Finding ways to make the dean's letter about each student more meaningful.
  • Planning ways to help the students who don't match so that they have a better chance the next time around.
  • Helping IMGs negotiate cultural differences — such as making eye contact or giving the correct kind of handshake — that could hurt them in interviews.
  • Helping IMGs use TMA’s IMG Section mentorship program and applications on the TMA website. 

The council will further study all of the suggestions brought forward and make a presentation regarding them at the 2019 TexMed conference in May.

Last Updated On

January 31, 2019

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Sean Price


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Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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