by Maria Benson, MS3, University of Connecticut School of Medicine

On March 21st, 2014, 25,687 medical school seniors found out where they would be attending the next phase of their training as residents in the National Resident Matching Program (NRMP) Match. Of these students, 16,399 were U. S. allopathic medical trainees, and 950 matched into Diagnostic Radiology.

Trends
There were 29,671 total positions offered as part of the upward trend of available spots seen in the last five years; this expansion has mainly been in the primary care disciplines, despite an overall decline of registrants and rank list submissions. Overall, 75 percent of applicants matched successfully, with 94.4 percent U.S. seniors matching. 50 and 54 percent of all students and U.S. graduating students, respectively, matched into their first ranked program of preference.
The most competitive programs were Neurosurgery, Orthopedics, Otolaryngology, Plastic Surgery, and Radiation-Oncology. There were 925 couples who participated in the linked match, and 843 were matched according to their preferences.

Diagnostic Radiology Positions
NRMP data trending the Match results from 2010-2014 show that although the number of Diagnostic Residency positions has been maintained, the number of positions filled has decreased as well as the percentage of total applicants who matched into the field; 0.8% in 2010 trended steadily downward to 0.5% in 2014. The percentage of positions filled that were offered to U.S. seniors has decreased from 84.2 percent in 2010 to the most recent metric of 68.9 percent. In contrast, the Surgery-Preliminary PGY-1 positions are increasing in the number of positions offered, with the percentage of positions filled rising in rough proportion. Medicine-Preliminary metrics have remained largely steady over the past five Matches.

The Match
The NRMP Match relies on an algorithm developed by engineer Alvin Roth, for which he was awarded the prestigious Nobel Prize in Economic Sciences in 2012. The NRMP itself is a non-profit organization established in 1952. In addition to the Residency Match, it coordinates the Specialties Matching Service, which serves to match current senior residents with their Fellowship programs. The Match continues to draw scrutiny from critics, who deem the system hardly economical. Forbes staffer Amy Ho recently published, “How A Nobel Economist Ruined the Residency Matching System For Newly Minted M.D.’s.” Though moderately negativist, Ho successfully points out that a cumulative sum of over 300 million dollars is spent annually on applications and travel among senior medical students, in preparation for double-binding agreement that defies the free market system. The algorithm, for its flaws, was a historic milestone in a notoriously conservative field; however, prior to 1952 hospitals were offering positions early, even before a student’s clinical years in order to secure the most competitive applicants.

Q & A: Recently matched seniors
We interviewed three stellar fourth year medical students who recently matched with the intent to pursue Vascular and Interventional Radiology: Alexander Sheu (AS) of the Feinberg School of Medicine at Northwestern University who matched at Stanford University School of Medicine, Nicole Zimmerman (NZ) of SUNY Upstate Medical University who matched at the University of Virginia’s Clinical IR Pathway, and Alexandria Jo (AJ) of the Medical College of Georgia who matched at the University of Michigan School of Medicine. All three have opted to do Surgical Intern years.

Name the most important factors in ranking your program of choice?
AS: Interventional radiology faculty, research opportunities, schedule flexibility, unique rotations, opportunities for innovation with nearby tech startups
AJ: Strong academics, patient volume, case diversity, research opportunities, resident and faculty camaraderie: proximity to diverse and scrumptious restaurants, strong collegiate football and basketball.
NZ: Location really matters. You want to be happy where you’re moving to. The opportunity for training in a specific IR pathway was very important to me. Caliber of the program, cost of living, availability of mentors in IR.

What advice can you give current MSI, II, IIIs?
AS: The most important thing is to find a mentor. Like us, faculty before us are indebted to mentors for looking out for them and advocating on their behalf. We are in medicine for the first time, and this is all new to us. Mentors look back on their careers and as always hindsight is 20/20. The faculty (and fellows, and residents) involved with SIR are fantastic mentors! The SIR MSC and research committee that I was the former student chair of is maintaining a database of mentors. (This is available here).
AJ: I advise younger MSIs and MSIIs to join or form DR/VIR interest groups, seek out research opportunities and actively interact with the radiology faculty members to gain more insight into the field. For MSIIIs, gear your rotations based on those relevant to VIR. These are hepatology, nephrology (dialysis), surgical ICU, cardiology, and vascular surgery. Seek out visiting clerkship opportunities to gain additional exposure, attempt to attend symposiums and meetings, and get involved at the national level with the Medical Student Council and/or RFS section of SIR.
NZ: Get involved in the SIR medical student council. Get involved in research. Do something to show that you love IR. To MSIIIs: If possible, set up an ICU elective. Enjoy fourth year because you’ll never have time like this again!

Any other comments about your Match experience?
AS: You will see many of the same people over and over on interviews – you may even become close friends with some of them! Interviews are a fantastic way to meet people with similar interests from all over the country. I couples matched with my wife in dermatology. If you have unique circumstances, do speak up during the interview process. It can only help you coordinate complicated situations.
AJ: There is slight confusion as to which programs officially offer the VIR pathway since there is a discordance between the information available of the StudentDoctor forum, the RFS section on the SIR website, and the NRMP program codes. There is also a wide range of responses from VIR program directors when addressing the issue of “allowing cross-overs between DR and VIR”. Thus many students that are interested in the VIR pathway have to seek out information on their own by contacting the interviewing programs directly. This is understandable and inevitable considering the VIR pathway is in its very early stages. I hope radiology programs strive to provide future applicants with a more solidified outline of their adoption of the VIR pathway.
NZ: There were many amazing candidates out there interested in IR which was nerve-wracking but it also showed that we’re recruiting many intelligent and motivated students into IR. The future of IR is looking bright!

References:
2014 NRMP Main Residency Match Results Press Release: http://www.nrmp.org/wp-content/uploads/2014/03/2014-National-Resident-Matching-Program-NRMP-Main-Residency-Match-Results-Press-Release.pdf
2014 NRMP Main Residency Match Advance Data Tables: http://www.nrmp.org/wp-content/uploads/2014/03/2014-NRMP-Main-Residency-Match-Advance-Data-Tables-FINAL.pdf
Ho, Amy. How a Nobel Economist Ruined The Residency Matching System for Newly Minted M.D.’s. Forbes.com: http://www.forbes.com/sites/theapothecary/2014/04/15/how-a-nobel-economist-ruined-the-residency-matching-system-for-newly-minted-m-d-s/