May 2001
Volume 65 |
Number 5
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| National
Residency Matching Program Results for 2001: Another Increase
This Year |
Alan W. Grogono,
M.D.
This is the ninth in a series of annual Spring updates about
the results of the National Residency Matching Program (NRMP)
for anesthesiology. In 1993, the first article was provoked by
an initial slight decline in recruitment. Surprisingly, in view
of what followed, I expressed concern about the decline and concluded
that it would be desirable to generate strategies to enhance our
ability to continue attracting both excellent medical students
and excellent graduates into our specialty.
Twelve months later we were worrying about oversupply so were
the medical students who, about four years later, demonstrated
the awesome power of the marketplace. As a result, there is now
a shortage of anesthesiologists, and for at least two years now,
we have resumed worrying about recruitment.
NRMP Results [Table 1]
Overall this year there has been a 21-percent increase in recruitment,
a similar increase to last year. Once again, it is almost entirely
attributable to a rise in the number of graduating seniors entering
anesthesiology from U.S. allopathic medical schools (from 549
to 713). This is the fifth year in a row that recruitment of U.S.
medical students increased [Figure
1]. From the low of 169 in 1996, there have been annual increases
of 50 percent, 53 percent, 10 percent, 29 percent and now 30 percent.
The increase in recruitment this year is slightly greater for
the PG-1 group (39 percent) than for the CA-1 group (26 percent).
Positions Unfilled
The number of positions offered through the NRMP increased from
1,005 last year to 1,104 this year (10-percent increase), still
well below the all-time high of 1,386 in 1993. Because there was
a greater increase in the number recruited, the number of positions
remaining unfilled fell from 204 to 131, about 21 percent of the
maximum number of positions unfilled, which reached an all-time
high of 622 in 1996.
Distribution of Recruits [Table
2]
The most striking trend of the last six years has been the ongoing
increase in the number of U.S. graduates recruited (from 169 to
713). This was initially accompanied by a rise in the number of
other medical graduates [Figure
2]. Since 1997, however, the number of other medical graduates
has stabilized at about 250. That number now represents about
27 percent of the total because of the rise in the number of U.S.
allopathic student recruits.
Among the nonallopathic medical graduates, only four categories
contribute significant numbers. This year, osteopathic physicians
were the largest category; their number has roughly doubled each
year since 1997 (from 7 to 107). By contrast, the number of non-U.S.
citizen international medical graduates (IMGs) fell from a high
of 213 in 1997 to 79 this year. The number of U.S. citizen IMGs
has changed little, providing 50 recruits this year. The sponsored
physician group grew this year to 15 recruits. The remaining three
groups, (fifth pathway, Canadian, U.S. physician) provided nine
recruits between them.
Of the available pool of applicants in each category, anesthesiology
once again attracts the highest percentage of applicants from
graduates of U.S. osteopathic medical schools (8.62 percent) and
U.S. medical allopathic schools (4.93 percent). In these two categories,
recruitment is above our average of 4.12 percent of the total
available via the NRMP.
Regional Distribution [Table
3]
The NRMP data for the last five years has also been compiled
by state and ranked by the numbers recruited into each state’s
residencies via the NRMP. For the second year in a row, the two
largest totals were California (106) and New York (93); those
two states recruited 20 percent. The next three states recruited:
Texas 70, Massachusetts 68 and Pennsylvania 65. Between them,
the top five states recruited 402 (41 percent), and the top 10
recruited 582 (60 percent). During each of the last five years,
California has recruited the largest number. For four years in
a row New York, Texas and Massachusetts have occupied the next
three positions, but not in the same sequence. Most states recruited
more this year than last. Nearly half of states matched all of
the positions that had been made available via the NRMP. The following
states recruited fewer this year than last year: Arizona, Colorado,
Louisiana, Michigan, Nebraska, Oklahoma, Washington and West Virginia.
Distribution Among Schools and Programs [Table
4]
The uneven distribution observed between states is just as evident
between individual schools and programs. This year, 713 graduating
U.S. allopathic seniors matched into anesthesiology. The closest
match to this number occurred in 1994 when 705 U.S. seniors matched
[Table 4]. 1994 was also
the last year of significant recruitment of U.S. seniors before
the major decline. This year has been selected for comparison
between the top 20 schools and the top 20 programs based on numbers
recruited.
The percentage attracted into the specialty was similar to last
year (about 4.95 percent), but the proportion of those recruits
entering anesthesiology from the top 20 schools rose slightly
from 36.6 percent to 39.4 percent this year. The number absorbed
into the top 20 residencies showed a slight trend in the opposite
direction: from 38.6 percent of all recruits in 1994 to 34.3 percent
in 2001.
Membership in these top 20 lists, as well as the rank order,
changed considerably in the seven years, with residency programs
demonstrating more consistency. Only six of the medical schools
still appear seven years later whereas 11 of the residency programs
appear seven years later.
More striking, perhaps, is the difference in membership between
the two lists in the same year. In 1994, only five institutions
appear in both top 20 lists, while six appear in 2001. Only a
single institution, the Medical College of Wisconsin, Milwaukee,
appears in all four lists. This exception only serves to emphasize
that, in general, the presence of a strong residency program is
not necessarily associated with successful recruitment of medical
students from that institution.
Comments
One year ago, there was an increased number of seniors graduating
from U.S. allopathic and osteopathic medical schools, as well
as increased numbers of U.S. citizen IMGs. The increase in the
number of recruits from U.S. allopathic and osteopathic medical
schools has continued. This year, the number of U.S. citizen IMGs
has decreased, and the number of sponsored graduates has increased.
The total recruited this year via the NRMP is 95 percent of the
peak number (1,025) recruited in 1992. The major difference appears
to be that there were 347 unfilled positions in 1992 and only
131 unfilled this year.
Adequate employment opportunities continue to be abundantly available,
as was mentioned in the February 2001 Ventilations in the ASA
NEWSLETTER. The shortage of anesthesiologists ensures employment
for several years. For individual members of the profession, this
must be good news. For a profession committed to the widespread
distribution of expert anesthesiology care, however, it is a handicap.
When and if the threat of oversupply reappears, we should treat
it with a moderation born of this recent cycle. A mere mention
around our operating rooms of an adequate supply of anesthesiologists
will probably suffice to modulate the supply of recruits. Our
Abt reports* and discussions of “limits on residency numbers appear
to be overkill and almost certainly contributed to our current
shortage.
Sheer size of a residency program is not the only yardstick for
success. However, the association between size and eminence is
far from random. By contrast, there appears to be no association
between eminence and recruitment from one's own medical student
population. Indeed, some of the most successful anesthesiology
residency programs recruit astonishingly few of their own students
into the specialty. This year, the top three residency programs
absorbed 64 recruits but were associated with schools that provided
only 12 students between them.
This disparity invites speculation. In the spirit of provoking
discussion, and perhaps research, some of these speculations follow
in a style encouraged by the relief we all feel in once again
being popular:
The top 10 reasons given by major anesthesiology chairs when
asked to explain why they recruit so few of their own students:
10. I travel to too many meetings to meet students.
9. When they graduate, they should get away from here and travel.
8. They all decided to do surgery before even applying to medical
school.
7. I’m never in the operating room.
6. What students?! You’re telling me medical students come here,
too?
5. How can I meet students, I'm always in the laboratory?
4. Students are smarter than me, and they scare me.
3. Students are smarter than me, and that really scares them.
2. Our anesthesiology residency actually makes a surgery residency
look attractive.
And the number-one reason given by major anesthesiology chairs
when asked to explain why they recruit so few of their own students:
1. Other medical schools have far better students!
Conclusion
Recruit! Recruit the best! Welcome any eventual oversupply and
merely greet it with a carefully orchestrated whisper to selected
students: We may have enough for the present.
Web site
Detailed information about the numbers of students recruited
into anesthesiology from each school and the numbers recruited
into and graduating from each residency program is available at
www.grogono.com/nrmp.
Acknowledgments
It is a pleasure to thank Liz Lostumbo of the NRMP for sending
the data to me by e-mail. Her prompt response permits the rapid
production of this article. This article was prepared primarily
for publication in the ASA NEWSLETTER. I thank the Editor,
Mark J. Lema, M.D., for his agreeing that it should be simultaneously
made available on the Web site.
Dr. Grogono’s past NRMP articles have appeared in August 1993,
May 1994, June 1995, May 1996, May 1997, May 1998, May 1999 and
May 2000.
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Alan
W. Grogono, M.D., is Professor, Department of Anesthesiology,
Tulane University School of Medicine, New Orleans, Louisiana. |
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