Match Day
“Beware the Ides of March.” Caesar dismissed the fortune teller’s warning and died on March 15 after eight years of service to the Republic.
After years of work and hundreds of thousands of dollars, graduating US medical students also fear March.
March 15, 2024, was Match Day, the day thousands of graduating medical students find out if and where they will train in residency. I intentionally include the word “if” because many don’t realize that medical school acceptance and graduation do not guarantee that you will become a fully trained physician able to sit for your respective board examinations and subsequently practice medicine.
This Match Day 2024, approximately 5% of senior US medical school graduates still need to secure a residency position.
The horror that these students must feel, I can only liken to waiting ten months to give birth only to leave the hospital with your arms empty and your child in the NICU hanging on for life.
So, what determines who is chosen?
It is a combination of grades, test scores (USMLE Step 1 and 2), specialty choice, interviewing, and interpersonal skills, kind of like online dating.
To better understand what makes a program swipe right on a candidate and the mismatch of underrepresented minorities in competitive specialties, beginning with the 2022 main residency match, the National Resident Matching Program (NRMP) began the voluntary collection of demographic data in 10 representative specialties.
- Anesthesia
- Emergency Medicine
- Family Medicine
- Internal Medicine
- OB-GYN
- Orthopedic Surgery
- Pediatric
- Psychiatry
- Diagnostic Radiology
- General Surgery
From this data, it was very clear that underrepresented minorities tend to choose less competitive specialties to ensure they would be chosen on Match Day.
It is only the best of the best who apply to the competitive residencies. The result is that for the minorities who apply to the more competitive specialties such as orthopedic surgery and general surgery, their match rates were comparable to those of White applicants. The difference is that the number of female and Black/African American applicants choosing those specialties was smaller and, therefore, less represented.
And what happens to those who don’t match on Match Day?
They enter the arena to fight for the unmatched positions of the Supplemental Offer Acceptance Program (SOAP). It is a gladiator fight, most for spots in less competitive specialties, such as Family Medicine or Pediatrics.
The data also shows that increasing diversity in medicine needs to start well before Match Day.
However, we also know that it must continue after because even the rock stars that match the competitive residency programs are not safe.
Minority residents either leave or are terminated from training programs in much higher numbers than their White counterparts.
A 2020 study found that groups from underrepresented minorities in orthopedic surgery were only 6% in total, but 17% were dismissed; in neurosurgery, the numbers were even more bleak, with 20% dismissed, many to leave medicine altogether.
Regardless of your professional path, your student loans must be repaid, so you can see why minority applicants choose the safe bet for Match Day.
The loss of these stars is like Christmas lights. You can lose one or two and the lights will still shine, just not as bright. However, there will be that critical light that goes out, and then the entire string of lights no longer works.
You can run the entire string and no longer know which one was critical. If only you had fixed that one light when you could see the whole string.
We are getting closer and closer to that critical stage as we lose minority physicians in competitive specialties, as we allow each of their lights to be turned off.
They are all valuable, those willing to reach unimagined heights, to light the way for the next generation, and to dream big dreams.
So, what will Match Day 2025 look like?
The lights are getting dimmer, but I see fewer plastic surgeons, neurosurgeons, and pediatric surgeons of color.
What do you think?