Trends in the Physical Medicine and Rehabilitation Match: Analysis of NRMP Data from 2007 to 2018

Abstract

Introduction We provide an updated analysis of data about U.S. Physical Medicine and Rehabilitation (PM&R) residency program applicants collected by the National Resident Matching Program (NRMP). Objective Analyze trends within NRMP data for PM&R residency match rates, compare matched to unmatched applicants, and compare PM&R applicants to other medical specialties. Design Secondary analysis of NRMP data. Setting NRMP data set. Participants Residency program applicants who participated in the NRMP Match, 2007 to 2018. Interventions Not applicable. Main Outcome Measures Number of applicants, match rates, difference in characteristics including rank order list (ROL), U.S. Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores, publications, Alpha Omega Alpha (AOA) status, PhD degree, and experiences in research, volunteer, and work. Results Number of applicants and residency positions increased from 2007 to 2018. Length of ROL increased and was longer for matched compared to unmatched applicants, with maximum mean difference of 7.4 in 2016 (95% confidence interval [CI] 5.6‐9.2). Matched U.S. Allopathic Seniors had higher USMLE scores compared to unmatched, with a mean difference of 12.7 for Step 1 (95% CI 8.3‐17.0) and 12.6 (95% CI 8.6‐16.6) for Step 2 CK (P < .001). Number of publications and volunteer experiences were higher for matched U.S. Allopathic Seniors (0.64, 95% CI 0.09‐1.2 and 1.5, 95% CI 0.65‐2.3, respectively). PM&R USMLE Step 1 and 2 CK scores increased at a significantly faster rate than for all other specialties, with estimated rate differences of 0.46 (95% CI 0.21‐0.71) and 0.69 (95% CI 0.45‐0.93) points per year, respectively. Conclusions PM&R residency has become more competitive. USMLE Step 1 and 2 CK scores have outpaced the inflation of scores in other specialties. ROL length has increased, suggesting more ranked programs to successfully match. These analyses update our knowledge about PM&R residency applicants and suggest surrogate markers for a successful match.

Letter to the Editor on “Trends in the Physical Medicine and Rehabilitation Match: Analysis of NRMP Data from 2007 to 2018”

“…We were very interested to read the article titled "Trends in the Physical Medicine and Rehabilitation Match: Analysis of NRMP Data from 2007 to 2018" by Claus et al and appreciate their updated analysis of the data regarding U.S. physical medicine and rehabilitation (PM&R) residency program applicants. 1 This article validates that securing a PM&R residency has become more competitive and provides useful comparisons between matched and unmatched applicants. We applaud the authors for emphasizing longitudinal data specific to PM&R and highlighting factors correlated with a successful match into a PM&R residency program, which include length of rank order list andamong U.S. allopathic senior applicants-the number of volunteer experiences and publications.…”

“…In addition, IMG applicants may add to the diversity of PM&R though their high number of work experiences, as demonstrated in Table 3 of this article. 1 A lack of diversity in program leadership may contribute to unconscious bias, which may further exacerbate the lack of interview invitations and residency program selection of U.S. and non-U.S. IMG applicants. Programs should be encouraged to conduct internal reviews of their recruitment process to identify unconscious biases, provide training on unconscious bias to all staff involved, and focus on holistic recruitment strategies such as adversity indices and targeting applicants who are routinely excluded by traditional screening tools.…”

“…The authors well noted that although matched students of all groups had significantly higher USMLE Step 1 and Step 2 clinical knowledge scores than unmatched students, USMLE Step 1 performance may not be a reliable predictor of clinical skills acquisition and performance differences may be due to gender and race. 1 However, this metric has historically been used as an initial screening tool for applicants, especially IMG applicants, and the upcoming change to a pass/fail Step 1 scoring system may have an adverse impact on these aspiring physiatrists. Whereas a higher…”

Increasing lengths of rank order lists of applicants and programs of US medical residencies

“…This could be due to receiving fewer interviews than matched applicants, limiting the pool of programs they were capable of ranking. A study by Claus et al 11 showed unmatched applicants tended to have lower United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores along with other traditional measures of competitiveness than matched applicants, supporting this notion. A study by Liang et al 12 also found that unmatched applicants submitted significantly more applications to achieve the same number of interviews as matched applicants, further supporting this explanation.…”

The National Resident Matching Program: An Outdated Business Model Due for Reform

“…These findings of increased congestion in the NRMP are comparable to results from a previous study by Claus et al which analyzed trends in the Physical Medicine and Rehabilitation match and found an increase in the number of applicants in addition to increased rank order list length for matched applicants across 11 match cycles. 5 However, this study did not examine trends across multiple specialties, thus limiting any conclusions regarding the NRMP as a whole.…”