By Joshua T. Hanson, MD, MPH

Selecting a Residency Program in 2020

By Joshua T. Hanson, MD, MPH

A rite of passage occurs every March. Every year, senior medical students across the nation find out where they will be completing their residency training. Physicians and medical schools refer to it as Match Day. It is a day of celebration for students, their loved ones, their educators and their future program directors. The opening of the letter determines their specialty and their training hospital; for many, it is the major milestone in their professional development and is more meaningful than commencement.

The transition from medical school to residency was not always so organized. Residency programs, the programs that train physicians into their particular specialty after medical school, were developed in the 1920s. In that era, offers were made to students as early as the second year of medical school. It was not until the 1950s that the National Resident Matching Program was organized to “provide an orderly and fair mechanism for matching the preferences of applicants…with the preferences of residency program directors.”

The initial algorithm that was put into place has been remarkably stable and very successful, with only minor modifications in nearly seven decades. In the 1960s, economists David Gale and Lloyd Shapley described an algorithm that would solve the so-called stable marriage problem: a way to match two sets together while taking into account each element’s preferences. This was applied with great success. Economist Alvin Roth, known for his work in organ donation, contributed with a redesign in the late 1990s. This permitted the introduction of couples (i.e., two senior medical students wishing to link their preferences) to be introduced into the algorithm. For their work, Shapley and Roth were awarded the 2012 Nobel Prize in Economic Sciences. It had been a time-tested process. As in all aspects of life, the COVID-19 pandemic tested the Match Program and introduced uncertainty. In a usual year, students would travel around the country to interview at programs during the late fall and early winter. This would give them a sense of the program. Programs would be able to host applicants in order to understand how they would fit into the program. Unsurprisingly, that was not to be in 2020.

Early in the application cycle, the Coalition for Physician Accountability, an umbrella membership organization for many national medical organizations, issued recommendations that all interviews be conducted online in recognition of the dangers inherent in traveling. Schools, programs and students recognized the value in these recommendations and complied. This meant new support systems would need to be implemented along with the development of new skills. At the Long School of Medicine (LSOM), support programs were created; these programs included sessions on increasing online presence, management of accessible interview rooms and an ability to borrow hardware, such as webcams and ring lights to improve their experience. Additionally, LSOM residency programs greatly increased their online presence to present themselves to applicants that would otherwise not be able to visit.

Still, when March began, there was much concern over what The Match would hold. It remained a resounding success. The total number of positions offered was 38,106: the highest on record. This represented a growth of 2.7% from the previous year. Despite this, the percent of all positions filled also increased to 94.9% from the previous year. After the algorithm was run, 1,927 positions remained unfilled, which was a decline of 3.6% compared to 2020.

It was no different at the Long School of Medicine. First and foremost, the overall match rate was consistent with that of allopathic senior medical students, indicating the school’s senior class was very competitive in the national job market. It is also clear that LSOM students love the city and the state. For the class of 2021, 23% have chosen to train in San Antonio and 58% will remain in Texas. Primary care remains very popular for the school’s senior class, with 43% going into a primary care specialty. By matching to these training programs in these ways, LSOM physicians will continue to provide excellent care to the people of Bexar County and Texas for years to come.

Despite the numerous challenges 2020 presented, the medical education community proved resilient and adapted to the challenges. While the obstacles were substantial, the established processes with novel adjustments created an environment where students could proceed with training, programs could be filled with capable and preferred applicants and, most importantly, patients could receive excellent health care.

Joshua T. Hanson, MD, MPH is Associate Dean for Student Affairs at the University of Texas Health San Antonio Joe R. and Teresa Lozano Long School of Medicine. He is a member of the Bexar County Medical Society.