Monday, February 9, 2015

How Hard Is It To Match Into Anesthesiology? The Surprising Answer.

FiveThirtyEight has a very informative article about how the whole Match process came about. It gives an historical perspective of the horrors experienced by medical students and hospital residency programs prior to the institution of the Match. Some students would take the first offer that was proposed, whether they really wanted to go there or not, in fear of not receiving a residency position later on. Others would drop their commitment to a program when a better offer came around, leaving programs in a lurch. The Match has done a pretty good job of bringing order to this chaos.

The history of the Match started with algorithms developed using game theory. That's right, the future doctors of America have their whole professional lives dependent on how games are played. Developed by American mathematicians Lloyd Shapley and David Gale, the algorithms were first used to describe how to match up men and women for marriage. Since then, the program has been able to successfully match nearly 95% of medical students with a residency spot, with nearly 80% able to get one of their top three choices.

Now ideally every single student would be able to receive the residency of his or her choice. But of course it doesn't happen that way. Some residencies are much more competitive than others, resulting in a low match number for students. Meanwhile the less popular specialties go begging for applicants. They have no choice but to accept nearly everybody who shows even a hint of interest in going there. Therefore students who wanted to go into the undesirable programs were almost guaranteed to get in. The National Residency Matching Program has produced a tidy little graph detailing how competitive each specialty has in attracting medical students.

Last year, the NRMP showed that Plastic Surgery and ENT were some of the hardest fields to enter. Only about three-fourths of 4th year US medical students successfully matched into those programs. The numbers were even more abysmal for other students, like foreign medical graduates. They were able to get into those spots less than half the time.

By contrast, the least competitive programs had match rates of nearly 100%. For 2014, the surprising wallflower was Diagnostic Radiology. It was nearly impossible for future radiologists to not get into a radiology training program last year. Even FMG's had almost a 75% likelihood of matching into radiology.

While predictably Pathology and Internal Medicine were shunned by many medical students, look who rounded out the top five in the most unwanted residencies--Anesthesiology. It was actually easier to match into anesthesia than, horrors!, Family Medicine. This was especially true for FMG's, who had about a 75% chance of getting into anesthesia compared to 50% for Family Medicine.

Of course this shouldn't come as a surprise to anybody who's been paying attention. Demand for anesthesiologists have been falling for some time now. The number of practicing anesthesiologists have increased at twice the rate of the general population growth for the last decade. Meanwhile the anesthesia residency program directors keep cranking out more new graduates every year. According to the NRMP, the number of PGY-1 spots in Anesthesiology has increased from 797 in 2010 to 1,049 last year.

The writing may be on the wall for the future of anesthesiologists. It is rapidly becoming a saturated medical specialty with too many providers scrambling for too few good jobs. Factor in the competition from non physicians, the anesthesia job market is on the verge of crashing under its own weight. Good luck to all the medical students on Match Day who want to go into Anesthesiology.


  1. This should not be too surprising given the fact that the administration of anesthesia is not, nor has it ever been, the practice of medicine. Yes, some physicians do administer anesthesia. But then again there is the old says that: “If your cat has kittens in the oven, it does not make them biscuits”. The practice of medicine is generally agreed to be the diagnosis and treatment of human disease and injury. I have inspected the ICD-10 from cover to cover and find do diagnosis of “lack of anesthesia”. The administration of anesthesia is essentially administering medication to patients and taking care of them. Since the Civil War this has been done quite well by specially trained nurses. I suspect that will continue.

    1. Ah, another nurse fabricating history. Yes, the most basic of anesthetics were first used by nurses. It was doctors, however, who pioneered the field, making it the safe field it is today. Furthermore, CRNAs are taught by MDs and the algorithms the CRNAs follow are developed by MDs. Don't overestimate scope of practice, it's bad for patients.

  2. A great field that has greatly been advanced by physicians....going down the drain. In this age of medicine where everything has an algorithm and protocol, no wonder it looks so appealing to nurses. Not all advanced practice nurses think in this manner, I've met some great ones who truly view medical problems in the same way that physicians do. Not every patient fits into a neat algorithm!

    Everybody wants to be a doctor....but no one wants to go through the process. Why should they when we as a society are making these shortcuts so appealing. In much the same manner that DOs had to fight for equal recognition with MDs, DNP/DNAP will soon be viewed as equal but with a different focus (hmmm, this sounds familiar). Eventually, DOs/MDs/DNPs will be competing for the same residency spots and will be addressed as "doctor". That being said, I don't necessarily believe that this is a "bad" thing if we can stop with this medical school propaganda. We're making it harder for physicians to become/remain physicians (extensive credentialing process, extending residencies, etc.) while making it easier for others to blur that line in the clinical setting. Sure the provider who has spent double the time in schooling/training may have the intellectual prowess to care for the patient with the obscure disease but how often do we encounter those patients? How often does this edge in knowledge really matter? For the overwhelming majority of patients, it doesn' how can medical schools justify sending people through the three-ring circus involved in becoming a full-fledged physician? The wasting of youth, mounting debt involved in medical education, delay of starting a family, delay in building savings, liability, etc doesn't quite make it seem worth it.

    I think the only field that is safe for an extended amount of time are the surgeons. But no worries, the RNFAs are just biding their time.

  3. Very well put!
    3 ring circus indeed!