I posted this on a thread in the Allo forum, thought it might help here also:
1. There were 26400 PGY-1 spots in the match this year. We can ignore the PGY-2 spots, since everyone who gets one of those needed a PGY-1 spot. This is an increase of about 2000 spots compared with last year, half of which were in IM.
2. Some, if not most, of the increase in spots in the match this year were probably from the all in policy. Many programs have been all in forever. Some take everyone outside the match. Some did both -- filled half their spots outside the match, and the other half inside. This year, those programs were forced to be all in or all out. Most went all in (as they didn't want to lose the 1/2 of their residents that were AMG's in the match), so those spots that previously were pre-matches are now in the match. Hence, much of the increase in spots in the match this year do not represent the opening of new positions, but rather a shift of positions from pre-matches to matched positions.
3. The number of US grads in the match was relatively constant from 2010-2012 at 16500, give or take. This year we saw an increase to 17400. The AAMC has called upon medical schools to increase class sizes by 15%. Many schools have increased class sizes, but often by less. If we assume a 10% increase (a number I have completely fabricated based upon no data whatsoever), that would increase the 16500 --> 18100.
4. There have been a few new allopathic schools that have opened. Some are in development, might fail due to budgetary issues. If we assume that at least 6 new schools open, perhaps with an average class size of 125, that would be another 750 graduating seniors, for a total of 18850.
4b. After all that work, I see that the answer is readily available. This table:
https://www.aamc.org/download/321442...actstable1.pdf shows matriculants to US medical schools for 2012. Bottom of the table, you'll see 19517 new students enrolled in 2012. Few will fail out, so presumably we'll see that many graduates in 2016. A bit "worse" than my back-of-the-envelope calculations.
5. On the osteopathic side, there have also been class size increases and some new schools opening. AACOM's website says there were 5600 matriculants in 2011-12, and they predict 6600 matriculants by 2015. How many of these will match in the AOA match is unclear, but let's assume "worst case scenario" where there are no new AOA spots and all of the increased 1000 of them enter the NRMP match. Adding that to the 2600 DO students already participating in the match, and we have a grand total of 23100 US seniors participating in the match.
6. Assuming no growth in the number of GME spots, we'd have a match with 26400 spots and 23100 US grads including DO's. This ignores the early match, and military spots. So even with all of the growth, I don't see the number of US grads exceeding GME spots. It's clearly going to get tighter and more competitive, and just being an "average" Carib grad might not yield a match.
7. Will GME spots grow? That's a very hard question to answer. The ACGME is not actively creating new spots. The ACGME simply accredits programs and defines their maximal size based upon educational resources. They are not trying to manage the physician supply in the US. GME funding is capped, such that most new spots that open are unfunded. Whether an unfunded spot is budget positive, negative, or neutral is a hotly debated topic, and depends heavily on assumptions made about replacement costs etc. Some hospitals have closed due to financial pressures, and that might actually decrease residency spots (although funded spots that are closed can be redistributed to programs that open new spots, so chances are every closed spot will simply reopen elsewhere)
8. The "physician shortage" often mentioned is also in the eye of the beholder. We are told that there will be a physician shortage due to more people getting insurance, and baby boomers retiring and becoming ill. In the latter case, once the baby boomers die, we'll need less docs. And, whether we have a doc shortage depends on practice models (i.e. docs practicing alone vs working with a team of NP/PA's), practice sizes, specialist needs and supply, and distribution. It's really complicated, and I don't pretend to be an expert in this area. Some experts feel we have a distribution problem -- too many docs in urban / popular areas and/or too many specialists.
The TL;DR version:
- This year's match demonstrated a slight increase in unmatched US grads compared with the prior 2 years, but similar unmatch rate to 3-5 years ago. Hard to know if this is the tip of an iceberg, or a fluke.
- US Grads are increasing in numbers, and will continue to increase for the next few years.
- Totally unclear what will happen to total GME training positions due to too many variables. Most likely outcome (IMHO) is level supply vs slow growth.
- I expect GME funding will be cut due to budget constraints.
- Match will become more competitive for all.
- IMG's will feel the brunt, and will have increased difficulty matching.
- Programs that are mixed AMG's/IMG's will probably shift to more AMG's as the supply increases.
- Programs that are 100% IMG's and are outside the match will probably stay outside the match.
- As competition increases we will have a higher rate of US grads not matching, which will trigger a debate about whether the match needs to be reformatted to allow US graduates and/or US citizen IMG's "first shot" at positions. There is no "right" answer to this debate. Some believe that spots should be earned purely by merit. Others believe that we have a vested interest to support our citizens first.
Theoretically, it can happen in the US - the government can't stop people from studying something, even if it's playing in an expensive and time consuming lottery. It's a free country after all.
