Exploding Popularity

With the creation of the integrated residency and gaining official specialty status from the Board of Medical Specialties (ABMS), the last few years will be remembered as the rebirth of Interventional Radiology as the clinical, patient facing speciality that it has become. However, with its bright new spotlight, the field has run into a major problem – more trainees want to become IRs than there is the ability to train them.

Per every measure we follow- SIR RFS/MSC membership, regional symposium attendance, conference attendance, etc- medical student interest in the field has never been higher. This massive influx of interested trainees is bringing high-achieving and incredibly enthusiastic students, but the difficulty in obtaining a training position has potential to be a major deterrent for potential trainees.

Unfavorable Odds

The competitiveness of the match has been a source of many rumors over the past two years. Many of these rumors painted the IR match as insurmountably competitive, even to the point that some residents are advising future students to punt on the IR match and focus their application on the DR and ESIR route. Because the NRMP only releases the full detailed data from the match every other year, our best reference point until now was the from the 2017 match data that showed that 281 applicants ranked at least one of the 125 available positions- a staggeringly low 44% match rate. Far lower than any other specialty, this rate assuredly intimidated anyone interested in IR. Thankfully, this year’s Charting the Outcomes of the Match finally answers the question of just how hard it is to get into IR.

There is no agreed upon way to determine competitiveness, but in most measures, IR was near the top and in some cases an extreme outlier. The ratio of US Senior medical student applicants (who rank the specialty #1) per available position is often used in the literature as a direct surrogate for competitiveness. In the 2018 match, IR topped this list at unparalleled 1.51 US Seniors per position. The difference of 0.38 between IR and the second highest, Orthopedic Surgery, was the nearly the same as the distance between Orthopedic Surgery and Psychiatry at 1.13 and 0.74, respectively. A historically low 58.3% of US Seniors who ranked an IR program first ultimately matched into IR, which was even lower than last years 69.4% (*47.5% of applicants who ranked any IR program matched into IR). When looking at the raw fraction of US medical students applying to the number who matched, IR was clearly the most competitive specialty and the 2018 IR match was one of the most competitive of all time.

However, when comparing the characteristics of the applicants, this massive gap between IR and other competitive specialties all but closed. With an average Step 1 score of 246 for matched applicants, IR came in sixth with Plastic Surgery and Dermatology tied for the highest average of 249. Interestingly, the Step 1 score difference between the matched and unmatched IR applicant (4 points) was the lowest of any speciality. In the number of posters/presentations/publications, the average matched IR applicant’s 8.4 was the seventh highest, trailing far behind the highest 18.3 of Neurosurgery. IR also ranked 7th in percent of matched applicants elected to their school’s AOA chapter with 31%. Dermatology had the highest with 49%. From this we can conclude that the average matched IR was of similar caliber to the other competitive specialities’ applicants which is likely near the the theoretical “roof” of medical student objectively-measured performance.

The Caveat

The statistics for the traditional measures for competitiveness paint a grim picture for IR hopefuls, but they might be drastically misrepresenting applicants’ satisfaction with their match results because nearly everyone also applied into DR.

This effect is demonstrated best by the average number of contiguous ranks where IR stood out as an extreme outlier. The NRMP defines the number of contiguous ranks as the number of programs in the same speciality as the number one program that are ranked before ranking a program in a different speciality. For example, ranking UT San Antonio IR number 1, UT San Antonio DR number 2, then 20 additional IR programs would count as only 1 contiguous ranking.

The median number of contiguous rankings for matched applicants in each speciality was 12.5. For most specialities, this number is a rough representation of how many interviews each applicant went on, but since each field interviews differently, it is difficult to interpret much from the data. For example, the very competitive Neurological Surgery had the highest with 16.4, while Dermatology had the lowest (non-IR) with 9.3. IR had far away the lowest average number of contiguous rankings in recent history with only 5.4.

This data can be interpreted in two different ways: The most pessimistic explanation would be that the relatively huge amount of applicants drove down the amount of interviews offered per applicant well into the single digits, and that it is indeed a brutally competitive process. However, judging from the discussions with my fellow applicants from the 2018 match, this is unlikely the full story, as most people ranked their more desirable DR programs after their top IR programs but ahead of their less desirable IR programs. It is likely the contiguous ranking average is heavily skewed by these applicants who are relying on ESIR or Independent pathways, and that many applicants ended up relatively satisfied at their highly ranked DR programs. While this effect can’t be definitively quantified from provided data, it is notable that only 2 (brave?) applicants exclusively ranked IR programs. Interestingly, however, the amount of applicants who ranked any IR program but not as a their first ranked speciality (29.7%) is perhaps the most telling figure. This percentage was slightly over double that of the second highest (General Surgery, 14.7%), which creates an surprising paradox as IR was both the most competitive specialty and the biggest “back-up” specialty.

Overall, the conclusions about trainee satisfaction in pursuing IR that you can draw from this analysis are limited, especially with the rumored “anti-IR bias” of DR programs. Still, it is safe to assume that published the competitiveness rates represent a worst-case-scenario and that it is likely that many applicants ended up at DR programs that they chose over IR programs.

So, was Interventional Radiology the most competitive specialty? Technically, yes. But actually, maybe.

Written by Charles Hyman, PGY1, Interventional Radiology, UT Health, San Antonio

References:

Chen JY, Heller MT. How competitive is the match for radiology residency? Present view and historical perspective. J Am Coll Radiol. 2014 May;11(5):501-6. doi: 10.1016/j.jacr.2013.11.011. PubMed PMID: 24793041.

National Resident Matching Program, Results and Data: 2017 Main Residency Match®. National Resident Matching Program, Washington, DC. 2017.

National Resident Matching Program, Results and Data: 2018 Main Residency Match®. National Resident Matching Program, Washington, DC. 2018.

National Resident Matching Program, Results and Data: Charting the Outcomes in the Match® Characteristics of U.S. Allopathic Seniors Who Matched to Their Preferred Specialty in the 2018 Main Residency Match. National Resident Matching Program, Washington, DC. 2018.