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Match Results 2023: Why Did Emergency Medicine Do So Badly?

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Emergency medicine has had its ups and downs over the years with regard to desirability. Soon after the show “ER” became popular, emergency medicine programs also were suddenly in vogue. Over the interim years, the field’s cachet has declined and increased, but up until recent years, emergency medicine programs routinely filled 99% of their available spots in the Match.

The fact that 554 emergency spots went unfilled in this past Match was particularly distasteful to many emergency physicians, accordingly.

The reasons for this plummeting interest in the field is well described in a recent piece in ACEP Now. (ACEP stands for the American College of Emergency Physicians.) The authors note multiple issues, including burnout, decreasing remuneration, and systemic problems in the emergency healthcare system that frustrate clinicians. 

Of note, these issues have driven out many middle-aged emergency physicians, as well.

Even if you are not interested in becoming an emergency doctor, take a look at the piece here, keeping in mind that certain factors may soon adversely affect other specialties as well.

(I’d like to give a shout out to my old friend Jonathan Fisher MD MPH who was one of the reporters on this article.) 

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Match Schedule 2022-3

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Here are some important upcoming dates for those applying for the Match:

January

Jan. 31, 2023: The registration deadline for the NRMP Match is at 11:59 pm EST on this date. After this time, applicants will incur a $50 late fee. (The process is expensive enough; no need to pay more.)

February

Feb. 1, 2023: Rank order list entry opens at 12 pm EST.

March

March 1, 2023: Rank order list deadline. Candidates must have their rank order lists certified by 9 pm EST.

March 13, 2023: NRMP Match Week starts. SOAP applicants can begin preparing applications in the ERAS® system.

March 16, 2023: SOAP rounds 1-4.

March 17, 2023: NRMP Match Day. Match results are available at 12 pm EST.

Over the course of this month and next, I’ll be blogging with tips on how to create your best Match list.

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Your Residency Application: Six Factors to Prioritize When Creating Your Rank List

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Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want – first goes first, second goes second, etc.

2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.

3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.

4. Consider whether you could spend your whole life at the institution or in that program’s location. It’s a lot to grapple with, but many residents graduate and stay for the rest of their careers.

5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

6. Realize that most programs will train you well if you work hard. Their prestige and quality may be more similar than you think. For that reason, note that your personal preferences and intuitions are paramount.

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Your Match Rank Order List Should Be Completely Uncoupled from Institutional Feedback

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I’ve recently received some email asking about how Match rank order lists should be affected by positive feedback applicants receive from interviewers and/or program directors. The answer is not at all. Because of the way the Match algorithm works, what programs think of you should have zero bearing on how you make your rank order list. See this recent blog that covers mistakes to avoid when making your list.

It’s really impossible to know about the program’s interest in you anyway. Even if a program tells you straight up that you will be ranked to Match, that isn’t a promise. I’ve known applicants who were “promised” a ranking to Match that never happened. 

Bottom line: It doesn’t matter what the programs think of you; it’s all about what you want. Here’s a good video about the Match algorithm if you’d like to understand the process more granularly. 

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The Rank Order List Deadline Is Approaching: Check Yourself Before You Wreck Yourself

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This is an important reminder that Wednesday, February 20 at 9pm EST is the rank order list certification deadline. Start now to think about your priorities and specifically, where you will be happiest. Waiting until the last minute and making impulsive changes to your list is not a great idea.

Please make sure to avoid simple missteps in creating your rank order list. Improving written materials and interview skills is important, but all of that work can go down the drain if applicants do not understand basic strategies for the Match. In November of 2015 the NRMP published an article called, “Understanding the Interview and Ranking Behaviors of Unmatched International Medical Students and Graduates in the 2013 Main Residency Match” in the Journal of Graduate Medical Education. The data is especially important for IMGs who represented the majority of unmatched candidates.

Sadly, the authors found that some applicants made strategic errors including the below:

– Not attending all interviews, thus failing to capitalize on every opportunity to market themselves.

– Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.

– Misunderstanding the Match and ranking programs at which applicants did not interview.

– Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

Here is an explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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