Let’s dive into the results of the 2024 NRMP Residency Match. Did emergency medicine make a comeback, or is it still a declining specialty? Why are more DOs applying? Did the 2024 Match finally address the physician shortage?
Record Number Primary Care Positions
In the most recent residency application cycle, there was a 92.9% fill rate for primary care residency spots. While that may sound decent, it’s actually a 1.2% drop from last year’s match. Some people might start sounding the alarm and say that the physician shortage is only getting worse, which is something we should be thinking about, but let’s look at the data first before we jump to any conclusions.
There could be a few different reasons for this fill rate drop.
First, it could be that people are generally less interested in primary care specialties due to reimbursement rates decreasing, the rising fear of mid-level encroachment, or even concerns about AI replacing some aspects of medical care. There isn’t the same guarantee that med students can have a long career, which might create hesitancy about going into primary care.
Med students also know that procedural-based specialties, such as surgery or OB/GYN, are much harder to replace, they tend to pay better, and AI most likely won’t be able to do the surgery from start to finish in our lifetimes. If the student plans on working for a long time, they would prefer to go into a specialty where they can work for as long as they want to.
Another reason for the drop in people going into primary care could be Nepal’s USMLE cheating scandal that unfolded over the past few months. IMGs and FMGs are vital for many residency programs to fill, and IMGs/FMGs tend to match better into primary care specialties.
This match cycle, of the roughly 9000 IMGs or FMGs who matched, 70% of them matched into primary care. That’s much higher than any other group, as the overall percent of medical students going into primary care is 46.8%.
With program directors being generally more critical of their FMG applicants, it makes sense they might rank fewer FMGs than they normally would. However, when looking at the raw numbers, 800 more FMGs matched this year compared to last year.
This is the opposite of what many people predicted and likely has to do with FMG applicants increasing by over 1500.
| 2023 | 2024 | |
|---|---|---|
| IMG Total Matches | 3,356 (67.6%) | 3,181 (67%) |
| IMG Total Applications | 4,963 | 4,751 |
| FMG Total Matches | 5,031 (59.4%) | 5,864 (58.5%) |
| FMG Total Applications | 8,469 | 10,021 |
However, the best explanation for the 1.2% drop in matches in primary care is actually the massive expansion of the number of spots in these fields. Family medicine had 5088, and internal medicine categorical had 9725 spots in 2023.
This year, family medicine had 5213 spots, and internal medicine had 10,260. In total, there was over a 4% increase in all of the primary care residency positions offered within one year.
So even though there was a record number of medical students going into primary care, on paper, there is a percentage decrease that could make it look like the physician shortage is only getting worse.
Emergency Medicine Numbers Are Rebounding
If you followed last year’s match trends, you likely heard about what people called the death of emergency medicine. There was an unprecedented 554 emergency medicine seats that went unfilled.
Articles forecasted the job market for EM would crash and that everyone who went into emergency medicine would need to find a new career. However, hindsight is 20/20, as it looks like emergency medicine has made a strong recovery.
There are two main reasons for this.
First, emergency medicine was the specialty hit the hardest during COVID. For a few years, this negatively impacted how students viewed emergency medicine, but with the world being mostly back to normal, the students in this application cycle could be less worried and more willing to consider a career in EM.
The other more interesting reason has to do with who is applying to EM programs. Since 2020’s match cycle, there are nearly 22% more DO students applying for the match. This is a massive jump in DO students, and some of this spills over into emergency medicine.
Last year, 730 DOs matched into emergency medicine, whereas this year, there were 1047 DOs. Considering there were about 550 unfilled spots, an increase in 300 DOs matching will significantly help emergency medicine residency programs recover.
But when we look at the number of MDs matching into emergency medicine, there’s a sharp decrease. In 2020, there were 1713 MDs who went into emergency medicine, but this match cycle, there were only 1285. That’s a cumulative 25% drop over four years.
Based on the data, you could argue that MD students leaving these emergency medicine spots open makes them more attainable for DOs and IMGs.
It will be interesting to see how emergency medicine residency evolves over the next few years, but at least this year, emergency medicine filled the vast majority of seats.
Shift in the Demographics Applying to Match
Having touched on the fact that there are more DOs applying to medical school, let’s talk about the other demographic trends.
First, there are fewer US citizens going to international medical schools than before. The data is clear that if you go to a DO school, your chances are much higher than if you go to a Caribbean or any other international MD program. With more and more DO schools opening over the past few years, it’s encouraging to see applicants pick those new DO schools over Caribbean medical schools.
The data shows that there are about 650 fewer US-IMGs applying for residency than four years ago, with DO schools having a collective increase of almost 1500.
Learn more about the pros and cons of a Caribbean degree.
The other interesting demographic shift is there has been an increase of nearly 3100 Foreign Medical Graduates applying for The Match over the past four years.
An FMG is someone who is not a US citizen and is completing their medical education in a foreign country. In contrast, an IMG is someone who is a US citizen and is completing their medical education abroad.
They are similar in that they both complete medical school outside of the US, but IMGs have a major advantage as they don’t need to be sponsored for work visas, which is something that some programs don’t want the hassle of figuring out.
Even though there was a slight percentage decrease in FMGs matching from 59.4% to 58.5%, there were 1250 more matched FMGs because the raw number applying is so much higher. It will be interesting to see if the number of FMGs applying staggers in the coming years, but right now, FMGs are the second most common applicant group, only behind USMD applicants.
With many more FMGs and DOs applying than ever before, there was a substantial 12% increase in the total number of applicants in just four years.
Fewer Positions Filled Through SOAP
When looking at the raw numbers, there are still more trends that stand out. For example, there were just under 39,000 seats filled through The Match, which is a 3.3% increase from last year. With more matches, fewer positions were filled through SOAP (the Supplemental Offer and Acceptance Program.)
SOAP is a way for medical students who applied but did not match to have the opportunity to fill an unfilled position.
Learn more: Supplemental Offer and Acceptance Program (SOAP) Guide.
No medical student ever wants to SOAP. It’s a brutal, stressful week that could end with the student matching into a program they are not thrilled about or not matching at all and potentially needing to reapply next year.
The fact that fewer positions were offered through SOAP could mean that more students matched through the regular algorithm. Although the NRMP has not released detailed results from this year’s SOAP, the fact that fewer students need to SOAP is a promising trend.
Impact of COVID-19 on Medical School Students
This year’s matched applicants are also the group who started medical school right at the beginning of the COVID-19 pandemic. They had to endure years of Zoom medical school lectures while simultaneously adjusting to the rigors of medical school.
It’s quite remarkable to see how they not only coped with COVID but demonstrated incredible resilience and dedication to medicine. You can bet they’ll carry that same determination with them as they start their residency.
Specialty Competitiveness
The last aspect to touch on is specialty competitiveness. There have been some interesting trends with some specialties getting record-high fill rates. Some people assume this means those specialties are now more competitive.
The NRMP even went as far as saying, “The results of the Match can indicate the competitiveness of specialties as measured by the percentage of positions filled overall and the percentage of positions filled by U.S. MD and DO seniors.”
This statement is incredibly misleading. You should not solely use fill rate as the determining factor on how competitive a specialty is. If we did that, internal medicine and emergency medicine would top the charts this year, putting them ahead of fields like ENT, thoracic surgery, and orthopedic surgery.
Based on historical data, it’s safe to assume internal medicine did not jump over these highly competitive fields. Using residency fill rates alone to determine how competitive a field is would be a totally incomplete analysis.
We need to consider factors such as what percent of matched applicants are USMDs or from NIH top 40 schools, number of publications, Step 2CK scores, and many other considerations.
Med School Insiders has a comprehensive Specialty Competitive Index that does just this. And based on all of those factors, in 2022, internal medicine and emergency medicine were both actually in the ten least competitive specialties.
The NRMP will release new data later this year for the 2024 Charting Outcomes analysis. When this is released, we’ll update our Competitive Index and note if any specialties shift position. Check out these lists for the top most competitive and least competitive specialties.
