| |
May 1998
Volume 62 |
Number 5
|
| |
|
| National Residency
Matching Program (NRMP) 1998: A Further Increase for Anesthesiology,
Especially From U.S. Graduates |
Alan W. Grogono, M.D
Recruitment via the National Residency Matching Program (NRMP)
has been reviewed in a series of articles in the ASA NEWSLETTER
(August 1993, May 1994, June 1995, May 1996 and May 1997). The article
last year summarized the dramatic swings that occurred in these
five years and reviewed changes in our priorities and attitudes.
This year's results, both for graduates entering the Match and for
anesthesiology residency programs, are summarized below.
NRMP Results for U.S. Graduates in 1998 [Table
1]
This year, from U.S. allopathic medical schools, 388 graduating
seniors entered anesthesiology, an increase of 53 percent compared
to 1997 and 130 percent more than 1996. The number of these students
entering at the PGY-1 level rose from 80 to 118, and the number
entering at the CA-1 level rose from 173 to 270. When graduates
from other sources are included, the total number recruited rose
from 497 to 645, a 30-percent increase. This growth occurred almost
entirely in the number of U.S. graduates recruited. The trends
in distribution for the last nine years are shown in Figure
1. In this graph, the top section of each column is principally
comprised of international medical graduates (see section on Composition).
The number of positions offered through the Match declined
from an all-time high of 1,386 in the year 1993 to 946 in 1996
[Figure 2]. The number of positions
unfilled continued to rise from 456 in 1993 to a maximum of 622
in 1996. This year, there were 1,008 positions available, but
the number unfilled fell to 363.
Composition of Recruits via the Match [Table
2]
Last year, the rise in the number of U.S. graduates was accompanied
by a comparable growth in the number of international medical
graduates (IMGs), from 130 to 213. This year, the number of IMGs
has declined to 201 (-5.6 percent) in contrast to the 53-percent
increase in U.S. graduates. Recruitment from other categories
remains relatively small. The number of osteopathic students rose
from 7 to 17, and the number of U.S. citizen IMGs again rose from
22 to 34. The number of Canadian graduates (0 last year), has
rocketed up to two.
Distribution of Recruits [Table
2]
As a specialty, we appear to be particularly sensitive to the
risk, or even the appearance, of being unable to recruit U.S.
graduates and, therefore, of disproportionately recruiting IMGs.
The best yardstick is probably provided by the relative percentages
of the available pools being recruited. Thus, in 1996, 1.16 percent
of U.S. graduating allopathic students were recruited, while 1.81
percent of the noncitizen IMGs were recruited.
In 1997, recruitment into the specialty had risen slightly,
but the relative distribution remained almost unaltered. This
year, however, shows a major reversal. The percentage of U.S.
graduates recruited has risen to 2.65 percent, while the percentage
of IMGs (2.51 percent) has fallen and is now smaller than U.S.
graduates (i.e., recruitment via the Match does not support the
hypothesis that there is disproportionate recruitment of IMGs).
Regional Distribution [Table 3]
Similar to last year, the data are ranked by state for the number
recruited via the Match. This year, the two largest totals, California
(91) and Texas (54), accounted for 22 percent of all candidates.
The next three states recruiting were Massachusetts (51), New
York (43) and Florida (34). Between these top five states, a total
of 273 candidates were recruited (42 percent).
Comment
Perhaps the single most important lesson about physician demographics
during these last five years has been the power of the marketplace.
It is almost as though the medical students themselves are our
best barometer. All over the country, they learn from us, they
learn quickly and they learn early and well. When we fear that
positions may be scarce, we transmit this fear to students, and
the same students provide prompt correction for our recruitment.
In this context, the return of U.S. graduates must reflect
greater confidence that positions are available now and will be
so in the future. Certainly, as other specialties fill up, anesthesiology
has many attractive features. One of the most compelling must
be that a majority of the public appears to prefer having a physician
in charge of their anesthesia* and about
90 percent of the anesthetics are currently medically supervised
or administered directly by anesthesiologists. Significant unemployment
for physician anesthesiologists is difficult to imagine in the
foreseeable future.
Acknowledgment
It is a pleasure to thank William Teel of the NRMP for extracting
the data and making it available so promptly. Without such help,
timely production of this article would be impracticable.
* Based on an independent survey conducted
in January 1998 by The Tarrance Group, Washington, D.C., 81 percent
of seniors 65 and older do not want the Health Care Financing Administration
to eliminate its current requirement for physician supervision of
nurse anesthetists for Medicare/Medicaid patients.
Alan W. Grogono, M.D., is Chair and Merryl
and Sam Israel Professor, Department of Anesthesiology, Tulane
University School of Medicine, New Orleans, Louisiana.
return to top
|