INFLATION OF FAMILY MEDICINE RESIDENCY APPLICATIONS

Last year, graduates from MD-granting medical schools in the United States applied to an average of 23.7 family medicine residency programs and interviewed at 11. This year, applications were projected to increase again to 25.8¹ (a 57% increase since 2009). During this same time period, allopathic family medicine graduate medical education (GME) positions offered through the National Resident Matching Program (NRMP) have increased 18% from 2,730 positions in 2011 to 3,216 positions in 2015; fewer than one-half of these positions were filled by US MD seniors.²

The increased applications per residency slot are creating a burden on residency programs as they strive to adequately review applicants. This congestion in the application review process may also lead to some applicants being overlooked. The NRMP 2014 Program Director Survey reported that at least 80% of family medicine program directors are reviewing the following: USMLE step 1, 2, and CS scores; MSPE; family medicine letters of reference; personal statement; and the perceived commitment to our specialty. Interestingly, a Best Evidence Medical Education (BEME) systematic review found low to moderate correlation of grades, step scores, and LOR with post graduate training performance.³

Why is this happening? The AAMC Careers in Medicine “Apply Smart for Residency” video tells students via a looming bar graph, “Residency slots aren’t growing at the same rate as graduating medical students. So, an already complex and competitive situation has become even more complex and competitive.” Unfortunately, there is not huge competition for family medicine residency spots among US MD seniors and this increase in applications has not resulted in a significant increase in students choosing family medicine. From 2011 to 2015, there was an increase of just 105 US seniors matching into a family medicine residency program.² Additionally, the video statement made by the AAMC is not accurate according to Mullan et al. who report that the GME system is proving responsive to the increased output of US medical students and that there is not a shortage of GME spots.⁴ The AAMC data also suggests that the unmatched rate for all US students has remained unchanged for the last 5 years, around 3%. Weissbart et al found no improvement in the match rate when students submitted an increased number of applications.⁵ Despite this data, students perceive more competition and are applying to more programs and some are being counseled to use family medicine as a “backup plan.”

This influx of extra applications from US students choosing family medicine, when there were more than twice as many family medicine GME positions offered last year than US MD students that were matched into family medicine, is unreasonable and unsustainable. Sifting through increased applications is not a productive use of a program director’s time when there are increasing demands from ACGME around curriculum and milestone assessments. One possible solution would be to advocate for a limit on the number of applications per student. Another would be to educate students on the facts about matching into family medicine, eliminating some of the fear that is driving this change. We can promote a more holistic approach and ensure residency programs do a better job marketing what they are seeking in an ideal candidate, as well as assisting students in being more specific in identifying what type of program they are seeking. Lastly, we can advocate for social accountability and work more closely with our medical schools in encouraging more students to choose primary care as a career.

• © 2016 Annals of Family Medicine, Inc.