Long considered the equivalent of an NFL Draft Day for physicians, the National Resident Matching Program's recent national match day ensured that more than 25,000 medical school graduates will pursue their training in primary care and specialty care. More than 40,000 physicians applied for nearly 30,000 positions.

Conflicts and perceptions continue to be debated about solutions for the physician shortage; yet no one has concrete answers. Despite the opening of 11 new allopathic medical schools since 2007 and the development and expansion of osteopathic schools, the number of residency slots, funded by Medicare, has remained unchanged since a Congressional Balanced Budget Act took effect in 1997.

The Affordable Care Act provided $230 million to increase the number of residency slots and to redistribute unused residency slots for primary care residency positions. Priority for awarding the residency slots was given to programs with rural training tracks, an emphasis in geriatrics or the addition of primary care slots, according to the U.S. Department of Health and Human Services. Is this a true expansion of residency slots, or just a reshuffling of what already existed.

The signs from this year's Match are encouraging, but not overwhelming. It's always good to see an increase, even if it is a very small step in the right direction. Rural and underserved areas still are in need of increased access to primary care providers across the country, says Mike Shimmens, executive director of the National Rural Recruitment and Retention Network (3RNet).

This year, the Match offered 29,671 first- and second-year positions, 500 more than in 2013 and an all-time high. More than half of the additional positions were in the primary care specialties of Internal Medicine and Family Medicine (NRMP press release, March 21, 2014). More specifically:

  • Internal Medicine programs offered 6,524 positions, 247 more than in 2013; 99.1 percent of positions were filled, and 48.5 percent were filled with United States medical school seniors
  • Family Medicine programs offered 3,109 positions, 72 more than in 2013; 95.8 percent of positions were filled, and 45 percent were filled with U.S. medical school seniors

What opportunities await the 15,000 physicians who did not match to a residency program. They could scramble for one of the unfilled residency slots in a specialty that was not their first choice. They could apply for a research fellowship. They could teach or go back to school for another degree. They can go through the Match process again next year, but it will  likely have more candidates and will be even more competitive.

Few of these choices increase the supply of practicing physicians or address the demand of access to care. At best, it will be at least three more years before we know how many of the physicians in this matching class will complete their residency program, choose to begin to practice, or select a fellowship for further training. Patients living in the rural and underserved areas and patients affected by Medicaid expansion may learn that their healthcare options really have not changed.

Expect topics like this to be discussed at the National Rural Health Association's  37th Annual Rural Health Conference starting this Wednesday, and follow me on Twitter for developments from that conference.

Follow Jacqueline Cavnar on Twitter @jcavnardrg


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