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2021 NRMP Specialty Match Sees Record Numbers

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The number of applicants to the Specialties Matching Service (SMS) of the National Resident Matching Program (NRMP) continued to grow this year, as did the number of fellowship positions, according to the latest NRMP report.

“The total number of active applicants in the SMS has grown more than 24% since 2017, and graduates from DO-granting medical schools have increased by 82%,” said NRMP President and CEO Donna L. Lamb, DHSc, MBA, BSN, in a news release.

Altogether, 12,925 applicants competed for 11,767 fellowship positions offered by 5110 programs, making the 2021 appointment year the largest on record.

Of the positions offered, 10,433 (88.7%) were filled; 4169 (82%) of the participating programs filled all available fellowships.

Of the 68 participating subspecialties — including a new obstetrics and gynecology subspecialty (complex family planning) — 38 filled 90% or more of the positions offered. That is nine more subspecialties than in 2020. Seventeen programs filled less than 75% (four less than last year).

The most competitive subspecialties among those that offered at least 30 positions were gynecologic oncology, pediatric surgery, reproductive endocrinology, and female pelvic medicine and reconstructive surgery. Each of these subspecialties filled at least 95% of the positions offered.

Geriatric medicine, medical genetics, and pediatric infectious disease programs each filled less than 60% of the positions offered, and less than 55% were filled by US MD graduates.

MD, DO, and IMG Numbers All Rise

The number of US MD medical school graduates in the specialty match totaled 6822, a 5.6% increase from the 2020 appointment year. The number of US DO medical school graduates totaled 1730, a 10.3% increase from last year.

Among international medical school graduates (IMGs), 1667 were US citizens, a 4.9% increase from 2020. The number of non-US IMGs totaled 2646, a 11.9% rise from last year. However, combined US and non-US IMGs accounted for close to the same percentage of total applicants this year (33.3%) as last year (32.8%).

Non-US IMGs matched in high numbers to internal medicine subspecialties. For example, they composed 53.8% of the applicants who filled pulmonary disease positions; 46% for endocrinology, diabetes, and metabolism; and 40.3% for nephrology.

Most- and Least-Sought-After Subspecialties

Among US MD graduates, the subspecialty with the highest fill rate was gynecologic oncology, at 93%. The next four subspecialties by highest percentage of US MD graduates were pediatric surgery (89.4%), hand surgery (86.3%), reproductive endocrinology (85%), and female pelvic medicine and reconstructive surgery (82.3%). Nephrology had the lowest fill rate (25.8%).

US DO graduates matched to the highest percentages of fellowships in sports medicine (37.6%), medical toxicology (23.5%), rheumatology (20%), pain medicine (19.6%), and pediatric pulmonology (17.3%).

Cardiovascular disease had the highest number of fellowship positions and matches, at 1045 and 1042, respectively. The next highest was pulmonary disease and critical care medicine, with 657 positions; nearly all of them filled. Hematology and oncology filled all 638 fellowships, followed by gastroenterology, with 590 positions and 584 matches.

The big growth in fellowship positions speaks to the continued attraction of medical school graduates to specialties. Because of lower salaries for primary care physicians, as well as other factors, only a third of US doctors practice in specialties such as family medicine, general internal medicine, and pediatrics.

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