C. Buonpane1, S. Hayek1, M. Fluck1, H. Ellison1, M. Shabahang1 1Geisinger Medical Center,General Surgery,Danville, PA, USA
Introduction: Every year the United States (US) Main Residency Match seeks to couple medical school graduates with available residency positions. Historically, there have been more applicants than available positions. The majority of applicants completed their undergraduate medical education in the US; however, a growing portion of applicants are coming from international medical schools. International medical graduates (IMGs) play a crucial role in the physician work force in the US, filling shortages that cannot be met by US allopathic and osteopathic graduates alone. This study seeks to examine the trends in match rates of IMGs into US allopathic residency positions over the past thirty years.
Methods: US residency match data was obtained from the National Resident Matching Program (NRMP) for the years of 1986 to 2016. Linear trends were used to evaluate match data over time and subspecialty analysis was performed. Longitudinal 10-year match rate projections were also made.
Results:
In 1986, IMGs composed 4,965 of 21,357 applicants and 27.8% of IMGs successfully matched into a US allopathic residency. In 2016, IMGs composed 6,638 of 35,476 applicants and 52% matched (87% increase). IMGs were then separated into American citizens (US-IMG) and those who did not have American citizenship (non US-IMG). From 1986 to 2016, US-IMG match rates increased by 40% and non-US IMG match rates increased by 110%.
Allopathic residencies in primary-care specialties demonstrated overall growth in available positions over the study period and an increase in reliance on US-IMGs to fill those positions. Internal medicine filled 4.8% of 4,682 positions with US-IMGs in 1986 and 14.6% of 6,938 positions in 2016 (204% increase). Family medicine programs filled 4.3% of 1,960 positions in 1986 and 23.6% of 3,083 positions in 2016 (449% increase). Longitudinal ten-year match rate projections suggest that 15.3% of internal medicine and 30.2% of family medicine US allopathic residency positions will be filled by US-IMGs in 2026.
Categorical general and orthopedic surgery positions were also analyzed. In general surgery, US-IMG filled positions increased over 400% (from 1.3% of 1,249 positions in 1986 to 6.6% of 1,239 positions in 2016) with a projection of 8.1% of positions being filled by US-IMGs in 2026. In orthopedic surgery, US-IMGs filled 0.29% of 342 positions in 1986 and 0.83% of 717 positions in 2016 (186% increase).
During the study period, non US-IMG match rates also increased. Non US-IMG applicant filled positions increased from 9-29% in internal medicine (222% increase), 1.8-12.4% in family medicine (589% increase), 3.8-4.6% in general surgery (21% increase) and 0.58-1.1% in orthopedic surgery (90% increase).
Conclusion:The percentage of IMGs filling US allopathic residency positions has increased over the last 30 years and is projected to continue increasing. This increase in reliance on IMGs has been particularly strong in primary care fields.