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May 1997
Volume 61 |
Number 5
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| National Residency
Matching Program (NRMP) 1997: An Increase for Anesthesiology |
Alan W. Grogono, M.D., President
Association of Anesthesiology Program Directors
Recruitment via the National Residency Matching Program (NRMP)
has been reviewed in a series of articles in the ASA NEWSLETTER
(August 19931, May 19942,
June 19953 and June 19964).
They record the dramatic changes brought about by our responsive
marketplace. In addition, the comments they contain reflect our
specialty's rapid response to change.
The 1993 review reported the first signs of declining recruitment
and even discussed possible explanations: " ... diminution
in the number of graduating seniors selecting anesthesiology ...
inadequate exposure to anesthesiology ... recent emphasis on primary
care ... perceptions about our specialty ... anesthesiology no
longer regarded as a "life-style" specialty; hours longer;
reimbursement reduced; legislation repeatedly proposed ..."
In effect, the article expressed traditional concern about declining
recruitment, especially of U.S. graduates. A possible strategy
for increasing recruitment was followed by a very timid: "
...Whether this is attainable, or even desirable, warrants consideration.
..." However, the final sentence in the paragraph that followed
concluded more confidently: "Desirably, these discussions
will generate strategies to enhance our ability to continue attracting
both excellent medical students and excellent graduates into our
specialty." In other words, recruitment was still a respectable
word as recently as 1993.
By 1994, the NRMP report in the NEWSLETTER clearly reflected
the change in our attitudes and included "promoting recruitment
no longer appears to be a desirable objective." The concluding
sentences were: "Any projected decline in the need for our
services will be much less threatening if fewer people are seeking
employment. Our medical students appear to have anticipated the
government's desire to reduce recruitment into hospital-based
medicine, at least in our specialty."
The 1995 review was prepared in the light of the specialty's
response to the report prepared by Abt Associates Inc., with our
recognition of the impending impact of managed care. The consensus
reached at a recent meeting of the Society for Academic Anesthesiology
Chairs was quoted: "... reduction in the number of residents
in training was indicated, desirable, and anticipated ...."
That year the report also began to focus on some of the consequences
of change, particularly in the relative and absolute growth in
the number of international medical graduates (IMGs) being recruited.
The final conclusion firmly reflected the widespread satisfaction
that recruitment was diminishing: "... We should be grateful
that market forces appear to be creating a significant reduction
in recruitment, at least through the NRMP. The extent to which
this will be effective overall will depend on our other sources
of recruitment during the next 12 months."
The summary in 1996 reported the most dramatic fall in recruitment.
The PGY-1 and CA-1 years attracted only 43 and 126 U.S. graduates,
respectively. Despite this fall and growth in the number of IMGs,
U.S. graduates still predominated in the Match. A side effect
of the fall in recruitment was less uniform distribution of recruits
via the match; a few large programs absorbed the majority of the
candidates. The conclusion that year, however, reflected a trend
to re-evaluate the effects of this precipitous decline in recruitment:
"... If we fail to address the current trickle of American
medical graduates entering our specialty, a future shortage of
strong U.S. leaders at every level appears to be inevitable....
Continuing success for anesthesiology and patient care demands
that we always recruit, and that we recruit the best graduates."
One year later, we appear to be seeing some signs of returning
confidence in the marketplace.
NRMP Results for U.S. Graduates in 1997 [Table
1]
This year, 253 graduating U.S. seniors entered anesthesiology,
about 50 percent more than did in 1996. The number entering at
the PGY-1 level rose from 43 to 80 (almost double), and the number
entering at the CA-1 level rose from 126 to 173. Overall, the
number recruited rose from 324 to 497, a 50-percent increase.
The trends in distribution for the last eight years are shown
in Figure 1. The top section of each
column is principally comprised of IMGs (see section on "Composition
of Recruits via the Match").
The decline in the number of positions offered through the Match
has lagged behind the decline in the number of applicants. Consequently,
the number of unfilled positions rose from 186 in 1990 to 622
in 1996. This year, although the number of positions offered rose
slightly, the rise (48) was significantly smaller than the increase
in the number of applicants (153). The number of positions filled
and unfilled were exactly the same (497). The trends in numbers
of candidates versus positions offered are shown in Figure
2.
Composition of Recruits via the Match [Table
2]
With the rise in the number of U.S. graduates, there has been
a comparable growth in the number of IMGs, from 130 (40 percent
of the total in 1996) to 213 (43 percent in 1997). Recruitment
from other categories is relatively small: the number of osteopathic
students declined by 50 percent from 14 to seven, and the number
of U.S. citizen IMGs more than doubled from 10 to 22. For the
present, at least, Canadian graduates (zero this year), appear
to be finding their climate more attractive than ours.
Regional Distribution [Table
3]
This year, the data are presented by state in order of the number
recruited via the Match. The two largest totals are California
(60) and New York state (39). Just these two states recruit 20
percent of all the candidates. The next three states all recruited
very similar totals: Florida, 35; Texas, 34; and Massachusetts,
33. Between them, these top five states attracted 201 recruits
(40 percent).
Other Specialties
As we follow trends in our own recruitment and try to anticipate
our needs for the future, it is appropriate to remember that some
other specialties currently believe themselves to be oversupplied
as well as being in potential or actual competition with other
"providers," e.g., ophthalmology. Trends in other specialties
will inevitably affect recruitment elsewhere and will compound
the difficulty of anticipating the future for anesthesiology.
Conclusion
The increase in recruitment this year of graduating seniors from
U.S. medical schools may provide some reassurance to those concerned
about the supply of future leaders; at the same time, the continuing
modest level of recruitment overall may allay anxiety about the
risk of oversupply. In the light of continuing rapid change, it
is probably best to avoid additional commentary and let the figures
speak for themselves.
References:
- 1. Grogono AW. Medical student recruitment:
Match results for anesthesiology, 1990-93. American Society
of Anesthesiologists Newsletter. 1993; 57(8):35-38.
- 2. Grogono AW. Medical student recruitment:
Match results for anesthesiology, 1990-94. American Society
of Anesthesiologists Newsletter. 1994; 58(5):25-27.
- 3. Grogono AW. Recruitment, residency
size, and match results for anesthesiology, 1995. American
Society of Anesthesiologists Newsletter. 1995; 59(6):24-27.
- 4. Grogono AW. National residency matching
program (NRMP): results for anesthesiology, 1996. American
Society of Anesthesiologists Newsletter. 1996; 60(6):24-27.
Alan W. Grogono, M.D., is Chair and Merryl
and Sam Israel Professor, Department of Anesthesiology, Tulane
University School of Medicine, New Orleans, Louisiana.
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