A magazine for friends of the Warren Alpert Medical School of Brown University.

Diagnosis: ‘Residency Placement Fever’


The number of student applications for residency programs has gotten out of hand, researchers say.

For people with a greater than 50 percent chance of landing their top job choice and a greater than 90 percent chance of getting a job in their field, would it seem like overkill for each of them to apply for more than 40 jobs?

That’s exactly what’s happening every year among US students receiving MD degrees. The highly successful process of matching medical graduates to residencies has nevertheless become so frenzied that the authors of a new article in Academic Medicine explicitly question the rationality of the system. It’s driving up costs for students and severely disrupting the fourth year of medical school, they say.

“There’s been this inexorable intensification of the residency selection process such that it’s basically taken over the fourth year of medical school,” says Phil Gruppuso, MD, professor of pediatrics and of medical science at Alpert Medical School. “It so dominates student time and energy during the fourth year that it’s become very difficult to do any curriculum planning.”

Gruppuso recalls that he pursued only four pediatrics residency programs back in the 1970s. The statistics he uncovered with co-author Eli Adashi, MD, professor of medical science, show that by 2005, students across the country were applying on average to 30.3 programs. In 2015 the number reached 45.7. For specialties deemed highly competitive, the numbers go even higher: The average student hoping to be an orthopedic surgeon, for example, applied to 73 of the 163 potential programs.

The surge of residency program applications appears to derive from a perception among students that it’s necessary to ensure placement in a top program. Indeed, among all applicants to residency programs, the number of offers per applicant fell to 0.78 in 2015 from 0.96 in 1976.

But that decrease doesn’t affect graduates of US allopathic medical schools (those that award MD degrees). Instead the decrease has emerged as other kinds of students—most notably graduates of osteopathic (DO degrees) or foreign medical schools—have increasingly joined the fray, Adashi and Gruppuso found.

Among MD graduates in the US, the number of offers per applicant has actually increased, to 1.51 in 2015 from 1.37 in 1976. Moreover, between 92 and 95 percent of those graduates have successfully matched every year since 1982, the authors note, and since 1997 the chance of students matching to their top choice has remained between 50 and 60 percent.

“At the end of the day, if you are a US medical school graduate, you are virtually assured of getting a job,” Gruppuso says. “There’s an irrationality about it that is different than when most people are looking for a job and are running the risk of not finding one.”

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