The 11th annual report about the anesthesiology results
of the National Resident Matching Program (NRMP) shows
some slowing in the increased recruitment experienced
in the last few years. There was only a slight increase
in the recruitment of graduating medical students from
U.S. allopathic schools. Most programs (81 percent)
filled every position that they offered via the NRMP.
Table 1 (click
to enlarge) |
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NRMP Results [Table 1]
This year, a total of 1,211 were recruited via the NRMP
[Figure 1], a further 9-percent increase in recruitment
(14 percent last year, 21 percent in 2001 and 22 percent
in 2000). The total matching into anesthesiology beats
the 1992 record of 1,025 by 18 percent. The number of
graduating U.S. allopathic seniors matching into anesthesiology
only increased from 904 to 927, a 3-percent increase
[Figure 2]. This number is only 10 below the peak of
937 recruited in 1990 and 1991 and represents 6.47 percent
of the 14,331 U.S. senior students in the NRMP. Because
there are now more students in the NRMP [Table 2], this
is a little below the previous record of 6.7 percent,
which occurred in 1991.
Table
2 |
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The number of U.S. allopathic
medical students (Students) compared to
the total number in the NRMP for each
year. The actual number is now comparable
to the peak in 1990 and 1991, but the
total in the match is now higher. |
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During the years 1990-01, the total number matching
in all other categories (non-U.S. allopathic seniors)
increased from 156 to 260. Last year, the number fell
to 208, but this year rose again to 284, the highest
number recorded, beating the 1998 high of 257 by 11
percent [Table 3].
Positions Offered and Unfilled
The total number of positions offered via the NRMP increased
to 1,264 (an 8-percent increase this year compared to
a 6-percent increase last year), only 9 percent below
the all-time high of 1,386 in 1993. The number of positions
unfilled fell to 53, just under the 57 reported last
year, the fewest unfilled for anesthesiology since the
NRMP was introduced in its present form [Figure 4].
Distribution of Recruits [Table 3]
For five consecutive years (1997-01), the number of
osteopathic graduates matching into anesthesiology had
almost doubled every year. Then, last year, there was
a dip from 107 to 89 (17-percent decrease); this year
there was a 42-percent increase from 89 to 126. The
other nonallopathic groups [Figure 5] showed somewhat
similar increases with the exception of Fifth Pathway,
Canadians and U.S. physicians.
Table 3
(click to enlarge) |
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This table shows the distribution
into anesthesiology residencies from various
sources during the last eight years. This
year, as a proportion, there was a significant
increase in the number of osteopathic,
IMG/U.S., IMG/Non-U.S. and sponsored graduates
entering anesthesiology. As a result,
the total for non-U.S. allopathic students
has risen this year. |
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Figure 5 |
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Graph of the distribution of people
recruited via the NRMP 1996-2003. This
graph is based on the larger categories
in Table 2. There is some increase in
recruitment from U.S. allopathic medical
schools but a proportionately greater
increase in osteopathic students and U.S.
citizen IMGs. |
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Regional Distribution [Table 4]
The NRMP data for the last five years has again been
compiled by state and ranked by the number recruited
into each state’s residencies via the NRMP. For
four years, New York and California have occupied the
two top positions, recruiting 177 (41 more) and 122
(7 more), respectively. Between them, these two states
recruited 25 percent of the total this year. Of the
next three states, Massachusetts recruited 80 (an increase
of 15), Texas 80 (an increase of 3) and Illinois 68
(an increase of 3). Between them, the top five states
recruited 527 (44 percent), and the top 10 recruited
771 (64 percent).
In contrast to the general trend, there was a significant
decrease in the number matched for Pennsylvania (76
to 68) and Missouri (32 to 24). In Pennsylvania’s
case, this can be attributed to the decrease in the
number of positions made available as two programs are
no longer listed — Allegheny General and Western
Pennsylvania. In Missouri’s case, the drop can
be attributed to a reduction in the number matched at
one hospital.
Once again, about two-thirds of the states filled every
position that was offered in anesthesiology via the
NRMP.
Table 4 (click
to enlarge) |
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Electronic Residency Application Service (ERAS) Data
Toward the end of the application process, ERAS published
a summary of the trends in applications by specialty.
The principle changes were increases in the numbers
of U.S. graduates seeking positions in anesthesiology,
dermatology, pathology, physical medicine and rehabilitation,
plastic surgery, psychiatry, radiation oncology and
surgery; and decreases in emergency medicine, family
practice, med/peds and obstetrics/gynecology. Their
records showed an increase in the number of U.S. anesthesiology
applicants from 1,361 to 1,446 and a decrease in IMG
applicants from 1,459 to 1,132 (ERAS data, December
18, 2002).
Comment
The increase in recruitment has continued again this
year. However, there are some interesting changes
compared to last year. The striking increase in the
number of U.S. allopathic medical students may be
leveling off; the rise from 904 to 927 is relatively
small. The overall increase from 1,112 to 1,211 is
mostly accounted for by increases in the number of
osteopathic students (37), sponsored graduates (21),
U.S. citizen international medical graduates (13)
and non-U.S. citizen international medical graduates
(6). These numbers suggest that the increase in the
number of positions offered (1,169 to 1,264) is now
significantly greater than the number of available
U.S. allopathic candidates, providing an opportunity
for greater recruitment from other categories.
The number being recruited is now about 18 percent
larger than the peak in 1992 when anesthesiology was
one of the most popular specialties. This number,
however, must be set against changes that affect our
specialty. For example, the U.S. population grew by
nearly 12 percent between the census of 1990 and the
census in 2000.
The number of positions made available via the NRMP
(1,264) is still significantly below the 1993 peak
of 1,386. The major difference is that in 1993 there
were 456 positions unfilled. This year, only 53 positions
went unfilled.
The growth in recruitment also has been accompanied
by an increase in the range of distribution. In the
last three years, the largest two states have progressively
recruited 20 percent, 22 percent and 25 percent of
the total. Similarly, in these three years, the top
five have recruited 41 percent, 42 percent and 44
percent. It would appear that in times of growing
recruitment, the strong grow stronger.
Web Site
This article, previous articles and additional information
about the numbers of students recruited into anesthesiology
from each school and the numbers recruited into and
graduating from each residency program are available
at <www.grogono.com/nrmp>.
Acknowledgments
I wish to thank Mona Signer of the NRMP whose prompt
response permits the rapid production of this article
and Renee Overton for permission to quote the ERAS
data. This article was prepared primarily for publication
in the ASA NEWSLETTER. I want also to thank
NEWSLETTER editor Mark J. Lema, M.D., Ph.D.,
for his agreement that it may be simultaneously made
available on the Web site.
Past NRMP articles have appeared in the NEWSLETTER
in August 1993, May 1994, June 1995, May 1996, May
1997, May 1998, May 1999, May 2000, May 2001 and May
2002.
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Alan
W. Grogono, M.D., is former Chair and Meryl and
Sam Israel Professor, Department of Anesthesiology,
Tulane University School of Medicine, New Orleans,
Louisiana. He is now retired. |
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