Furman S. McDonald, MD, MPH

If I had one word to summarize this year's matching, it would be growth. This is a pretty impressive match.

In terms of internal medicine, a lot has gone up: total positions, total positions filled and total positions filled by U.S. seniors. That is all very positive. In fact, internal medicine is the most popular specialty choice if you look at absolute numbers of U.S. senior medical students going into any of the disciplines. We are on an at least a 4-year upward trend, so that is encouraging. But remember, internal medicine is also the prerequisite residency for 21 subspecialty disciplines, so some of these doctors who are going into internal medicine will end up in specialties like cardiology, rheumatology, nephrology, etc. But a good number of them will continue on in general internal medicine, and that will add to the primary care workforce, which is good.

Interestingly, there is an Accreditation Council for Graduate Medical Education (ACGME) program for combined training in internal medicine and pediatrics. Internal medicine training is usually 3 years and pediatrics is another 3 years, but with this combined training program, graduates can be eligible for certification in both internal medicine and pediatrics after 4 years instead of 6 years. For those programs, 100% of them filled, which is fantastic. Almost 96% of programs in internal medicine categorical residencies were filled, which is great, especially if you consider that internal medicine categorical has more than 25% of the total positions in the match. So, internal medicine is the largest discipline and it really did well.

There are more positions available than in the past, but the number of people entering the match has exceeded the number of positions that have been created, so there is more demand. There are several reasons. A few years ago, the Association of American Medical Colleges made a call to increase the number of medical student positions. So, schools that were already opened began to increase their class sizes. In addition, some brand-new medical schools were started. We are seeing now the first wave of graduates out of some of those newer medical schools. Another big thing — especially for internal medicine, which we are really pleased to see — is that ACGME and the American Osteopathic Association unified their accreditation systems. So, some doctors of osteopathy who used to be part of the DO match are now in the NRMP match. A good number of these young doctors want to train in internal medicine.

What caught my eye, which I thought was quite impressive, has to do with international medical graduates. There was a several-year decline in those who were born abroad and completed medical school abroad and came to the U.S. for positions. In this year’s overall match, it has really gone up quite a lot. In 2017, there were 7,284 of those applicants, and then it went down 7,067 in 2018 and 6,869 in 2019. Last year, it was 6,907. It went way up this year — 7,943. That is a 5-year high. Wow.

The American Board of Internal Medicine and others, in particular with the leadership of the Educational Commission for Foreign Medical Graduates (ECFMG), really advocated for immigration policies that would not hinder these young doctors from coming to the U.S. and completing their training without interruption. The flip side to that is many U.S. medical students who do not match will point to these other pools of candidates and say they are making it harder for U.S medical school graduates to match. But from a program director’s standpoint, you want the best people. And from a patient’s standpoint, you want the very best. Overall, U.S. medical school graduate match rates remain very strong despite the increase in the applicant pool. 

It looks like a lot of young people are wanting to become physicians, and a lot of them are wanting to go into internal medicine, which is ultimately very positive.