The annual residency report from the Association of American Medical Colleges (AAMC) reveals characteristics of medical school graduates and residents, including specialty insights, test scores, demographics, and professional activities post-residency. This year’s report shows that almost half (48.7%) of medical students graduating in 2019-2020 said they had a different specialty than planned at the beginning of medical school.
Those graduating with a specialty in child neurology were the most likely to have changed their minds from the beginning of med school (88.5%), followed by those in vascular surgery (74.4%), and plastic surgery (63.1%).
Students in orthopedic surgery were the most likely to stick with their original choice (48.7%, up from 44.8% in 2019), followed by those in pediatrics (39.1%), neurologic surgery (37.6%), and emergency medicine (36.8%).
Test scores on the US Medical Licensing Examination (USMLE) vary widely among specialties. Below are the highest average scores among first-year residents in 2019-20 for Step 1 and Step 2 Content Knowledge (CK).
Table. Highest Average Scores on Step 1, Step 2 CK by Specialty
|Specialty||Step 1 Score||Step 2CK Score|
|Thoracic Surgery (Integrated)||247.3||254.2|
Racial breakdowns also widely varied by specialty. Overall, several groups remain significantly underrepresented among the 139,848 residents in 2020.
Table 2. Racial Breakdown of Residents in 2020*
|Race Selected||% of Residents|
|American Indian/Alaska Native||0.6|
|Native Hawaiian/Other Pacific Islander||0.2|
*Residents could choose more than one race, and figures do not include the 16.5% of residents who are neither US citizens nor permanent US residents.
In terms of gender-based data, in some specialties women outnumbered men 2-to-1; in others, that ratio flipped. Women dominated in obstetrics and gynecology (83.8%) and pediatrics (72.4%) for instance; men were more prevalent in diagnostic radiology (73%), anesthesiology (66.9%), and emergency medicine (64.1%).
Overall, the number of residents increased by 4897 from 2019. However, the percentage who are international medical school graduates has decreased, from 25.9% in the 2015 report to 23.1% in the 2020 report.
The report also included a look at full-time faculty appointments at US MD-granting schools for those who completed residencies from 2010 through 2019. According to the report, 77.4% hold appointments at the assistant professor level (15.3% of the entire group who completed residency training). This percentage dropped slightly from the 77.6% of people who completed residency training from 2009 through 2018.
Medically Underserved Areas
Among those who completed residencies from 2010 through 2019, 25.4% said they are providing direct patient care in medically underserved areas (MUAs) across the United States.
Some specialties had high percentages of early-career residents practicing in MUAs, including child neurology (31%), internal medicine (27.3%), neurology (27.2%), family medicine (26.5%), and general surgery (26.3%).
By state, more than half of early-career physicians report having practiced in MUAs in Alabama, Mississippi, and Montana, whereas fewer than 10% in Maine, North Dakota, Wisconsin, and Wyoming said they had.
Overall, more than half (55.5%) who completed training from 2010-2019 continue to practice in the state in which they completed their residency. California had the highest retention of residents (77.6%), followed by Alaska (68.6%) and Texas (66.6%). Delaware had the lowest retention (38.3%) followed by New Hampshire (40.6%) and Rhode Island (42.8%).
More women than men (59.1% vs 52.5%) who completed residency training from 2010 through 2019 are practicing in the state where they trained.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick