The National Residency Matching Program® (NRMP) recently published its annual Results and Data for the 2018 Main Residency Match®. How competitive was emergency medicine (EM)? Spoiler alert: not much changed! But to understand the full picture, we need to dive into the numbers, which look a lot different from last year. Below is a summary of the most pertinent results for EM, trended from 2011-2018. You will notice some striking differences in the data between the 2017 Match and the 2018 Match.

More EM Programs in the Match

Importantly, there were 29 new ACGME-accredited EM programs that participated in this Match cycle. We are in the midst of a several year process called Single Accreditation, in which many programs previously accredited by the American Osteopathic Association (AOA) are applying for accreditation by the ACGME. As programs convert from AOA to ACGME, they leave the osteopathic match and join the NRMP Match. Many – but not all – of the new EM programs in the 2018 Match are those that successfully made this transition in accreditation.

2018 Match TrendDon’t miss the trend! Over the last 8 years, 70 additional EM programs entered the NRMP Match. That’s a sharp rise. What if another 70 programs have come online 8 years from now? It’s unlikely, as Single Accreditation will sunset by 2020. But we should keep our eyes on this trend line and the eventual impact it might have on the job market in EM.

More EM Positions Offered

As the specialty of EM continues to grow in the United States, there has been a corresponding rise in the number of entry positions offered in the Match. This happens in 2 ways: either (1) new programs become accredited or (2) established programs obtain funding to increase class size. This year’s increase, a total of 231 additional positions, certainly reflects the large number of AOA programs changing to ACGME programs. EM positions represent 7.5% of the total offered by the NRMP Match, up from 7.1% last year.

2018 Match TrendDon’t miss the trend! Comparing 2011 to 2018, an additional 671 EM interns now enter training in ACGME-accredited programs. Wow.

No Difference in U.S. Seniors

One of the most significant data points reported each year is the number of U.S. Seniors who match in EM. It’s significant because of the definition of ‘U.S. Seniors’: allopathic medical students in their graduation year at LCME-accredited schools in the United States, Puerto Rico, or Canada. ‘U.S. Seniors’ do not include osteopathic students, international medical graduates, or students who graduated in previous years. Despite a rise in the number of additional programs and positions, the number of U.S. Seniors remained flat, rising to 1,606 from 1,601 last year.

The 8-year Trend: Still upward! The difference in the number of positions filled by U.S. Seniors over this period is a net gain of 338, explained in part by the continued popularity of the specialty and the growth of new LCME-accredited medical schools. One concern: will the number of new programs ever outpace the interest in our field by U.S. Seniors? That would have a big impact on the ‘competitiveness’ of our specialty and perhaps the unfilled positions available in the SOAP.

EM was LESS Competitive in 2018. Or was it???

Students often view the number of available positions in the SOAP as a surrogate marker of competitiveness in a field. In my opinion, that is a data interpretation error. By that standard, EM is extremely competitive because we have observed a 99.9% fill rate for many years. However, all this statistic really tells you is that it is rare to enter EM through the SOAP.

The more important statistic to consider is the fill rate by U.S. Seniors. I just told you the number of EM positions rose by 231 this year compared with the 2017 Match… and the number of U.S. Seniors remained flat… so our fill rate by U.S. Seniors dropped from 78.4% to 70.9%.

For comparison, the following specialties each filled with > 90% U.S. Seniors in the 2018 Match: interventional radiology (97.1%), radiation oncology (93.8%), orthopedic surgery (93.1%), plastic surgery (92.9%), ENT (90.2%), and neurosurgery (90.2%). Let’s agree that these are some of the most competitive specialty programs in the Match for U.S. Seniors.

Previously, the EM fill rate by U.S. Seniors averaged close to 80%, similar in ‘competitiveness’ to OB/GYN and general surgery… until this year. Here’s what happened: Single Accreditation has resulted in a general increase in the number of available positions for most specialties, and therefore a drop in the fill rate by U.S. Seniors for those specialties. Osteopathic graduates now match at ACGME programs, thus affecting the fill rate by U.S. Seniors across all specialties. One might assume that the larger the specialty, the more AOA programs there are to convert to ACGME, the bigger the drop in the U.S. Seniors fill rate… but that didn’t happen. Yes, pediatrics (63.1%), family medicine (44.9%), and internal medicine (42.4%) each had an observable decrease in their fill rate by U.S. Seniors; however, these declines were much smaller than observed for EM. For comparison, this year OB/GYN was 78.7% and categorical surgery 76.2%.

How do we put this all together?

  • Most U.S. Seniors who choose EM will match, which has always been the case. There remain many more EM positions than interested U.S. Seniors. And now these students can apply to many more programs than before – overall good news.
  • Osteopathic seniors now only match in ACGME-accredited programs, rather than choosing between AOA and ACGME programs. This is good news for those who wanted to train at ACGME programs, because the number of available ACGME positions has increased. To illustrate, a total 484 osteopathic graduates matched to ACGME-accredited EM programs this year, up from 283 the year before. However, some AOA programs may choose not to convert to ACGME accreditation, resulting in a temporary decrease in the total number of EM positions ultimately available to osteopathic students. I say temporary because the general rise in the number of new programs and available positions will close this gap over time.
  • International medical graduates (IMGs) who take the USMLE now have many more programs available to them, thanks to Single Accreditation – good news for them. I remain cautiously optimistic for a subset of these applicants. A total 109 IMGs matched in EM, 80 of whom were Americans studying abroad; these numbers have remained fairly stable in EM over the past several years.

In summary, EM observed a decline in the fill rate by U.S. Seniors, which may be our best surrogate marker of the “competitiveness” of the specialty.

EM remains competitive, but not ‘very’ competitive. See, my Spoiler Alert was correct: not much changed in 2018.

Michael Gisondi, MD

Michael Gisondi, MD

Associate Professor and Vice Chair of Education
Department of Emergency Medicine
Stanford University
Editor, ALiEM EM Match Advice series