Match Day nears, with worries there still aren't enough residency slots

More than 40,000 medical school seniors and graduates who applied for 29,000 available medical residency positions will learn their fate Friday at 1 p.m. Eastern time.

The event underscores physician workforce issues and how, while the number of medical school students is increasing, the number of graduate medical education positions where new doctors train has remained flat. A record 49,480 people applied for medical school in 2014, and enrollment reached an all-time high of 20,343.

But increasing enrollment in U.S. medical and osteopathic schools has not eased fears of a national doctor shortage because a main consequence of increasing domestic medical programs is that fewer foreign students get assigned to U.S. residency positions, producing little net gain.

Some have compared the annual Match Day event with the National Football League's draft day as individual high-stakes dramas are played out in large ceremonies where students simultaneously open their Match Day letters. The proceedings and excitement are now captured and almost instantaneously sent out into the world via social media.

“At the medical school ceremonies, students are given personalized letters showing where they matched,” Mona Signer, the National Resident Matching Program's CEO, said in a release. “It's an exciting moment because it validates their years of effort and defines their future careers as physicians. We consider it a privilege to share in this life-changing day.”

There were 975 U.S. applicants who were not assigned a residency position last year. Their names were put into a pool for a second-round draft by institutions with unfilled resident positions.

Dr. Atul Grover, chief public policy officer of the Association of American Medical Colleges, said 425 applicants remained unmatched. Many of those students find medical research work or go back to school for additional medical school courses or to seek graduate degrees in areas such as public health and then reapply for residency spots.

“It's creating a pressure that will be interesting to watch on Friday,” Grover said, adding that there were about 800 graduates who didn't match in 2013 along with the 425 who didn't match last year.

The number of residency positions is growing by less than 1% a year while the number of medical students is growing by almost 2%, Grover said. Osteopathic medicine programs have grown by 8% to 10%, he noted. A Match Day for students getting Doctor of Osteopathic Medicine degrees took place Feb. 9 when 1,997 new D.O.s were assigned residency positions. A similar number of D.O.s will be part of Friday's Match Day, Grover said.

Residency programs are primarily funded by Medicare, which contributed $9.7 billion for GME in 2012. Some states such as Florida, Georgia, North Dakota and Texas have beefed up GME in efforts to shore up their physician workforce. The theory is that new doctors tend to practice where they train.

That holds true primarily for doctors who attended medical school and did their residency training in the same state, Grover said. Residency positions are disproportionately located in the Northeast, but states such as New York are considered “exporters” of medical residents, Grover said.

A 2014 Institute of Medicine report, written by a panel co-chaired by former CMS administrators Dr. Donald Berwick and Gail Wilensky, recommended a massive restructuring of the nation's GME program.

The AAMC was one of the organizations that spoke against the report, though Grover said the organization does support reforms for greater transparency and accountability of how public funds are used by training institutions.

“I don't know how much people want to destroy the current system and start from scratch,” he said. GME reforms or restructuring have to be part of an overall healthcare reform effort in order to have significance, Grover said.

Starting a new residency program from scratch can be a long and arduous process, but Nemours Children's Hospital, Orlando, Fla., is attempting it. The 100-bed, $397 million facility located in Orlando's Medical City at Lake Nona development, opened in October 2012 and has a tentative goal of starting a pediatric residency program in July 2017.

Dr. Heather Fagan, vice chair of education at Nemours Children's pediatrics department, left the University of Chicago where she had been since 1999 and came to Orlando last August for the opportunity of building a program from the ground up in a free-standing institution not connected to an academic medical center.

The long-range plan calls for a fellowship program to train pediatric subspecialists who have completed a general pediatric residency. But that goal is 10 to 15 years down the road, Fagan said.

Her current efforts involve working with third- and fourth-year medical students whom she later hopes to recruit into the residency program.

“Our intent is to start a brand new program,” she said. “We don't intend to have any shifts (of existing residency positions) or joint programs.”

Fagan said she thinks a successful program at Nemours will help build a strong physician workforce in central Florida.

Pediatric residents do tend to begin their careers in the region where they trained, she agreed. This is especially true of pediatricians who trained in community-based programs outside the walls of an academic medical center because they have built relationships and a referral base, she explained.

Follow Andis Robeznieks on Twitter: @MHARobeznieks