Happy Match Day Fellow Netizens!
Some of you may be reading this and wondering: “What is Match Day?” Match Day is a special day for all fourth year medical students throughout the United States when they discover where they will continue their medical training via their accepted residency programs. It happens every year in the month of March, and every medical school celebrates it with a lot of fanfare.
Not only should Match Day be a moment to celebrate the incoming cohort of doctors who have worked hard to get to where they are now, but it should also serve as a day of reflection over the system our nation currently has to train America’s future physicians. While most medical students match to a residency program, it is worth noting that some do not. Some of you Netizens may be aware that the United States is currently faced with a physician shortage, so the idea that some medical students were not able to match may sound baffling. “Don’t we want every graduating medical student to get into a residency program?” To understand this, we need to bring out some context first.
Match Rates: The Numbers
According to the most recent match numbers from 2023 provided by the National Resident Matching Program (NRMP), there were 40,375 available residency positions and 42,952 qualified applicants (mixed with both MD and DO students). These numbers indicate that over 2000 applicants were not able to continue their education straight from medical school and would have to re-apply in the next cycle. This is concerning given that the whole process can take several months to a whole year, with added effort spent to improve one’s application (read here to learn what it looks like to re-apply for residency).
From the data above, if you conclude that the lack of residency positions is a major issue for our country’s physician shortage, you are correct. Of all the reasons that you could come up with on why we have such few doctors in the United States, this should be near the top.
Hospitals, CMS and Congress: The Holy Trinity of GME
The United States trains its doctors through a system of progressive learning: medical school forms the basis of a future physician’s knowledge in medicine, followed by graduate medical education (GME, also known as residency programs) where practical skills are honed for the specialty doctors match in. How Congress and the Centers for Medicare and Medicaid Services (CMS) fits into all this comes down to one thing: money.
Fun Fact: Did you know that federal dollars account for the majority of funding for residency programs in our country?
Notes: Medicare’s payments for GME are based, in part, on the number of full-time equivalent
residents that a hospital trains. Caps reflect the number of residents eligible for the two GME payment types. Direct Graduate Medical Education payments offset direct costs of GME training, such as resident salaries, and Indirect Medical Education payments offset indirect costs of GME training, such as the additional cost of resident supervision.1
According to a report from the Congressional Research Service (CRS), more than $16 billion dollars was allocated to residency programs in 2020 via Medicare. This is not a number to scoff at considering that we need more funding to increase the amount of doctors we can train. The Balanced Budget Act (BBA) of 1997 passed by Congress placed a cap to the amount of Medicare funds available to be distributed to hospitals for their residency programs based on data from 1996 (that was 28 years ago!). This created a limit to the amount of positions available since not many hospitals had the incentive to pull resources outside of what the federal government was willing to allocate for them. The artificial bottleneck of the training pathway would eventually lead to the physician shortage we currently face today. There have been changes to the cap, more recently with the American Rescue Plan of 2021 and the Consolidated Appropriations Act of 2021 (along with its associated COVID-19 Relief Bill) , which added some funding for residency education.
This is interesting and all, but why do I should I care?
Great question! Well, assuming that you are a living and breathing human being, at some point you will need to see a doctor for a medical issue or a yearly check-up. If there are not a lot of doctors around to help you, you will have a hard time finding the care you may need (pretty obvious issue of supply and demand).
Several solutions have been floated around to fix the physician shortage; however it is clear that one of the biggest hurdles to overcome is the artificial cap on CMS funding available for residency positions. Increasing the federal budget for Medicare spending is a controversial proposal, yet it is necessary if we are to improve our nation’s healthcare system and provide adequate care for all Americans.
As we congratulate those lucky to match today, let us not forget that many who are qualified to move forward with their education were not able to do so. Also, we should emphasize that it is through no fault of their own other than how inadequate our healthcare system is at providing future physicians with the opportunity to start practicing. We wish them all the best and hopefully they will be able to get lucky next year.
Stay safe and Happy Match Day!
1Source: https://www.gao.gov/assets/gao-21-391.pdf
Featured Image: Photo by cottonbro studio: https://www.pexels.com/photo/people-toasting-wine-glasses-3171837/
Disclaimer: This article reflects the author’s own opinions and statements. They do not reflect the opinions or stances of any organization affiliated with the author.
