LETTERS TO THE EDITOR 2014 Residency Match Update and Call to Action COMPETITIVENESS

We previously described a decrease in interest among US medical students applying to radiology residencies from 2009 to 2013 [1]. The number of US applicants continued to decrease, and residency positions expanded in 2014. The number of positions per US applicant is a measure of competitiveness on a supply-and-demand basis. A smaller number indicates a more competitive specialty or year. Radiology’s positions per US applicant increased from 1.35 in 2013 to 1.51 in 2014. In terms of competitiveness, it fell slightly behind pediatrics and anesthesiology (Table 1). OVERSATURATION

Recent trends in the match should serve as an immediate call to action for organized radiology. Halting residency expansion or even contraction could be justified from two market views. First, the radiology job market remains in a slump and can barely support its graduates. Decreased utilization of imaging, bundled payments, lower reimbursements, and delayed retirements have all contributed to this problem. The radiology workforce is oversaturated, and decreasing the supply of new trainees can help each graduate find a job and potentially a position that he or she prefers. Various economic forces are causing radiology to trend away from highvolume imaging mills and toward the development of more specialized consultants. Producing fewer, highly trained graduates will help combat commoditization and allow radiology educators to focus on quality over quantity. If implemented, this change will not produce an effect in the job market for 6 years. However, there is no quick fix, and we should act now instead of kicking the can farther down the

Table 1. Competitiveness of the 2014 residency match by specialty ranked according to positions per US applicant Positions per US Applicant Specialty Tier 1 Urology Plastic surgery Tier 2 Otolaryngology Orthopedic surgery Neurological surgery Dermatology Tier 3 Radiation oncology Ophthalmology Tier 4 General surgery Obstetrics and gynecology Emergency medicine Internal medicine epediatrics Tier 5 Pediatrics Anesthesiology Diagnostic radiology Tier 6 Physical medicine and rehabilitation Neurology Tier 7 Psychiatry Internal medicine Tier 8 Family medicine Pathology

0.70 0.76 0.80 0.83 0.87 0.89 0.99 1.00 1.18 1.20 1.21 1.29

1.44 1.49 1.51 1.69 1.86 1.98 2.01 2.26 2.29

Note: A smaller number of positions per US applicant indicates a more competitive specialty.

road. Every long-term solution needs a first step in the right direction. SELECTIVITY

The second market force comes from medical students and their freedom to choose a specialty. For the past 5 years, their interest has fallen by 28% in terms of applications. The current state of the radiology job market has undoubtedly played a role. Radiology was the 7th most competitive specialty in 2009 and has now descended to 15th among 21 major specialties (Table 1). Being competitive has sentimental value, but it also means being first in line to choose the best students. If one

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assumes that radiology training requires a broad knowledge base and rigorous skill set, then the recruitment process needs to be relatively demanding. The glut of residency positions and continuous drop in the number of US applicants will further erode the specialty’s ability to be selective. A decrease in residency positions will have an immediate effect on the specialty’s ability to fill its positions with preferred candidates. TRENDS IN 2015

There were 81 vacancies in the 2014 match, and this trend will likely continue [2]. Proportionally, radiology had more unfilled residency positions than any other specialty except pathology. If programs do not fill, they should consider “rightsizing” and aim for quality over quantity. We expect that the number of US applicants will further decrease in the coming years because of the stagnant job market. A decrease in residency positions will have an immediate effect on the specialty’s ability to fill its positions with preferred candidates in the 2015 match and a long-term effect on job market saturation. Jim Y. Chen, MD Brigham and Women’s Hospital Department of Radiology 75 Francis Street Boston, MA 02115 e-mail: [email protected] Matthew T. Heller, MD University of Pittsburgh Medical Center Pittsburgh, Pennsylvania REFERENCES 1. Chen JY, Heller MT. How competitive is the match for radiology residency? Present view and historical perspective. J Am Coll Radiol 2014;11:501-6. 2. National Resident Matching Program. Results and data: 2014 main residency match. Available at: http://www.nrmp.org/match-data/main-resi dency-match-data/. Accessed May 20, 2014. http://dx.doi.org/10.1016/j.jacr.2014.06.001  S1546-1440(14)00320-2

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2014 Residency match update and call to action.

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