Transparency in the Ophthalmology Residency Match: Background, Study, and Implications

Abstract

Background Medical students are applying to dramatically more ophthalmology residency programs than in the past, causing an increased administrative burden for programs and financial harm to students. This study considers the background of this situation and looks at how a lack of transparency surrounding potential residency match filters contributes. Furthermore, this study raises several potential solutions to this lack of transparency that may increase the functionality of the ophthalmology residency match. Objective The purpose of this study was to determine the availability and consistency of potential ophthalmology residency match filters through training program websites and the American Medical Association’s (AMA) Residency & Fellowship Database (FREIDA). Methods This study was a cross-sectional observational study of ophthalmology residency program websites and AMA's FREIDA database entries. For 119 ophthalmology residency programs, five potential filters were evaluated for both availability and consistency on individual residency websites and FREIDA. These filters were: (1) whether a program required a minimum United States Medical Licensing Examination (USMLE) Step 1 score; (2) minimum number of letters of recommendation required; 3) whether a minimum USMLE Step 2 score was required; (4) if the program accepts the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) sequence in lieu of the USMLE; and (5) ability of the residency to sponsor a visa (J-1, H-1B, or F-1). Each program's website and FREIDA entry were independently evaluated by two authors to increase validity, with a third author brought in to break the tie in case of a disagreement. Results Only two ophthalmology residency programs had information about all five filters both available and consistent on their website and FREIDA. Inter-reviewer reliability was 92.5%. Conclusions Information about potential filters used in the ophthalmology residency match is neither publicly available nor consistent. This lack of transparency may contribute to the phenomenon of medical students applying to dramatically more ophthalmology residency programs. A standardized database of these filters is needed to increase transparency to applicants, which may reduce the expenses of medical students and the workload of program directors.

The Big Data Gap: Asymmetric Information in the Ophthalmology Residency Match Process and the Argument for Transparent Residency Data

“…e A list of additional benefits mentioned by programs include: adoption assistance, addiction services, blood donor club, business cards, campus currency, care coordination, cell phone discounts, childcare services, commuter services discounts, discount entertainment tickets, financial counseling, genetic testing, guaranteed resident housing, housing stipends, in-house gym, life/disability insurance, MBA program, meal stipends, mentorship programs, moving allowances, professional organization memberships, protected research time, scrubs, smartphone stipends, taxsheltered annuities, tuition reduction, unionization, work hour limitations, and white coats most students, and thus students rely on word of mouth and advising from administration to titrate their application decision-making. 2 Students with connections in the space or that attend a medical school with an associated residency program immediately have an advantage, as program directors may be able to guide students on both soft and hard requirements for application to certain residency programs. Understandably, students with a home residency program are 40% more likely to match than those without one.…”

“… 4 However, information on program applicant considerations or characteristics is often not readily available to most students, and thus students rely on word of mouth and advising from administration to titrate their application decision-making. 2 Students with connections in the space or that attend a medical school with an associated residency program immediately have an advantage, as program directors may be able to guide students on both soft and hard requirements for application to certain residency programs. Understandably, students with a home residency program are 40% more likely to match than those without one.…”

“…This study only evaluated the SFMatch program Web site, though other studies have explored separate databases in greater detail. 2 Additionally, this study only evaluated the presence of specific data points (e.g., applicant considerations, program characteristics and benefits) on the program Web site. Thus, the study risks misrepresentation of the total number of programs that may offer a benefit.…”

“…Given the consequences of failing to match in an increasingly competitive specialty, students are casting wider nets in order to maximize their chances of matching anywhere. 2 3 The number of applications submitted by students has increased from 48 in 2008 to 88 in 2023, representing a 87% increase or an extra $1,400 spent per student. 1 4 Thus, it is not surprising that a study by Venincasa et al determined that the greatest driver of the increased number of applications is “fear of failure to match.” 4 …”

Ophthalmology Residency Program Director Survey on Pass/Fail U.S. Medical Licensing Exam Step 1 Scoring

“…Over the last decade, the mean number of applications submitted by each student applying into ophthalmology has dramatically increased from 52 in 2011 to 79 in 2021. 11 The increasing number of medical students applying to residencies poses a range of challenges for residency program directors and admissions committees in order to conduct a holistic review of each applicant. As the number of applicants grows, the time and resources required to review each application in detail become increasingly prohibitive.…”