Dear Members of the Alliance for Academic Internal Medicine:
On behalf of the Alliance for Academic Internal Medicine (AAIM), thank you for your support of the alliance and its member organizations.
Another match day is behind us. My task in this letter is to place the 2009 Main Residency Match in context. Unfortunately, it is difficult to make the message upbeat. We all know the challenges that internal medicine faces in recruitment. I have been a program director for long enough to remember the “glory days” of 1985 when 3,884 US seniors matched into categorical internal medicine and the subsequent 36% nosedive that brought us to our low point in 1993 when only 2,473 US seniors matched. In the ensuing 16 years, we have stayed stable or even rebounded slightly, but we remain much closer to the bottom than the top.
This year, 376 programs offered 4,992 internal medicine categorical positions in the match, representing a slight increase in the number of programs and positions from 2008. Only 25 programs (7%) went unfilled, compared with 31 last year. The small number of unfilled programs is good news; however, I know from hard personal experience that when you are one of the unfilled programs, it is no consolation and perhaps even more painful to know that you are one of only a few. To the directors of those programs, I extend my sympathy and hope that things went well for you in the scramble.
This year, the fill rate for US seniors was 53.8% with 2,632 US seniors matched to categorical internal medicine programs. These numbers have remained stable for the past five years. We are 6% above the 1993 low point, but still 32% below 1985. On the plus side, because of the numerous talented applicants from medical schools not accredited by the Liaison Committee on Medical Education, 98.6% of categorical internal medicine positions offered in the match were filled. Without these applicants, many of our programs would be in crisis.
Overall, interest in primary care residencies has remained flat. All but two of the 50 primary care internal medicine residencies were filled, but the number of positions offered was down from 264 to 247. US seniors filled 155 (63%) of these positions. For historical perspective, in 1997 608 primary care internal medicine positions were in the match, and 368 US seniors matched. Although only 12 internal medicine-pediatrics (med-peds) programs out of 79 went unfilled compared with 17 last year, the US senior fill rate was unchanged at 68%. The number of med-peds positions offered (354) was down very slightly from last year; however, to put things in perspective, there were 464 med-peds positions in the match in 1997. In family medicine, the number of positions offered was down from 2,636 to 2,535, and the fill rate for family medicine for US seniors was 42%, a small decrease. Comparatively speaking, pediatrics had a good year. Only 29 pediatrics programs went unfilled compared with 40 last year, and the fill rate for US seniors was up from 67% to 70%.
The total number of students from US allopathic medical schools in the match continues to increase slightly each year; there were 16,008 students this year, up from 15,308 in 2005. The 30% increase in medical school enrollment called for by the Association of American Medical Colleges will increase this number, but it remains to be seen if this growth will affect the fill rate for internal medicine residencies. Participation in the match of osteopathic graduates (2,875 in 2009) and US citizens who are graduates of international medical schools (4,927) has continued to increase each year, and participation of international medical graduates who are not US citizens has also continued to climb (11,267 in 2009).
What does all this mean for internal medicine? When my predecessor, Keith Armitage, MD, wrote this letter a year ago, he predicted that we would not see a significant increase in the number of applicants for internal medicine until general internal medicine and, particularly community-based primary care internal medicine, is reinvigorated as a career choice. I agree. Like all of you, I interact daily with residents and medical students who see general internal medicine as a less attractive career than internal medicine subspecialties and other options. The practice environment, salary, lifestyle, workload, perceived prestige of the specialty, and negative perception of the role of the general internist in our health care system all continue to contribute to this perception.
It will take fundamental changes in our health care delivery system to restore the prestige and appeal of primary care internal medicine. AAIM must continue to work with the American College of Physicians and other organizations to help this cause. If a generalist career in internal medicine becomes attractive to students and residents once again, a future president of the Association of Program Directors in Internal Medicine will be able to write a match newsletter about how much things have changed for the better rather than about how they have stayed the same.
Don Bordley, MD
President
Association of Program Directors in Internal Medicine