USMLE Match 2013: Part 1: Positions per Applicant – Revealing the IMG Story

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This post has been long due, and I have been rather flattered that I received several “requests” for this post as a follow up to my previous ones; you can find the previous (recent) posts related to USMLE:

US Budget FY 2014: Did the US Govt Make USMLE Tougher for IMGs?

USMLE 2013 and IMGs: All That Glitters is NOT Gold

The USA Dream for IMGs: Coming to an end? Analysing the 2012 Match

The problem is, it takes quite a lot of time to go through the 116 page results document, in addition to the additional documents that the NRMP comes out with. Then there is the time to read and extract the bits I want to write about. And then finally sit down and write it out. It all means a significant time investment, which I have not been able to make of late. So, I finally decided that it was high time I got these posts out (since interview season is almost done, it is indeed too late for this post already), but I thought it would be better to send them out in parts as it would give me a better chance of writing them out. Once again, these analyses and interpretations are very personal and you should not judge the exam or make any career decisions based on these. I would exhort you to exert yourself and chase down your dreams and not let anyone’s blogging bog you down! Read on then…

This is a long post; if you do not have the time or the patience to go through this, I encourage you to scroll down to the last paragraph for the TL;DR version.

One of the most important metrics that goes into identifying how good a chance one has in any competitive exam is the metric of positions available per applicant. This has consistently been reported since the system came into being in the annual NRMP match report and has become a focus of attention for me. The importance of positions per applicant is in the fact that with each year more and more people compete for the USMLE and it is rapidly becoming a difficult nut to crack. We take comfort in the fact that each year more and more seats are added to the matrix and tell ourselves that it affords us slightly more breathing space, but the story doesn’t end there.

The real metric here at play is the positions available per active applicant. Now let us take a look at the numbers.

This year, a record number of applicants put their names in the hat. 40,355! This is an increment of almost 2,000 students as compared to last year. Out of these, there were 34,355 active applicants. An active applicant is anyone who has submitted a rank list. A lot of candidates withdraw from the match process, and they do not get counted in the final tally. The active application number went up by 3,000 as compared to last year. Here is the overall break-up of the numbers of applicants over the last 5 years:

Overall numbers of active applicants in the USMLE
Overall numbers of active applicants in the USMLE

There was a slight reduction in the number of US active applicants last year, following which there has been a major bump in 2013, which has led to a record number of US grads applying in 2013. However this is set to get worse in 2015 as a spate of new AMGs will flood the systems as they come out of the newly established schools and set foot into the entry portals of residency. How the numbers change then would be an interesting study.

Active US Senior Applicants in the USMLE
Active US Senior Applicants in the USMLE

The number of US citizen and non-US citizen (or, as we call them, the true IMG) international medical graduates who applied for the USMLE this year also saw a record bump in numbers (I get this feeling we are going to use this sentence over and over again in the days to come!):

Active US and non-US Citizen IMG Applicants in USMLE
Active US and non-US Citizen IMG Applicants in USMLE

With this backdrop in mind, we need to understand the implications of the calculations that follow. First up, if they seem extremely rosy as compared to last year, beware that this might be because of the “all-in or all-out” system that has been put up in place from the 2013 match onwards. There has been some discussions as to what that might mean in the long run, some of which I had summarised in a previous post here: USMLE 2013 and IMGs: All That Glitters is NOT Gold.

Before we move on to the finer numbers, let us take a look at the way the Positions Per Applicant (let me shorten it as PPA as I shall be using it abundantly in this post) has changed over time:

Positions/Applicant over time (AMGs red; IMGs dark blue)
Positions/Applicant over time

The edits I added in red indicate the values for the US graduates and the ones in what I believe is a dark blue is for the IMGs. In the 2013 match although there were a record number of unmatched US grads, it was also by far the best year for US grads to match in based purely on the metric of PPA. The assumption is that AMGs would have applied uniformly to all the specialties, but that is not the case. The NRMP has come out with detailed match statistics on a specialty basis this year, which I intend to pick up in a later post; it is most likely that the higher unmatched numbers are due to the fact that more AMGs tried to match into the more competitive specialties with lower match rates in general. This has led to a large number of unmatched candidates despite having a very favourable PPA overall. I shall dwell on this aspect in a later post.

Anyways, coming back to the PPA analysis, one thing that has stood out is that the NRMP has declared only the overall and US IMG PPAs. They have left the numbers for IMGs out. Although the data needed to calculate that has always been around, I do not think anyone really had the time to bother about it. The overall and US trends have usually been a good indicator of the stats. However, since more than half of the active applicants are US grads, it is most likely that the overall PPA would be pulled up by their numbers. Here again, we are working on the assumption that given a chance an AMG will match into a position when compared to an IMG (which should be how it is, considering that it is the American system after all and it would be unfair to disenfranchise the AMGs of what is rightfully theirs). Anyways, so I decided to calculate the figures for the IMGs in order to unearth what the prospects actually looked like for the IMGs.

Now the thing is IMGs can be of two types, the ever-growing numbers of US citizen IMGs and the non-US citizen IMGs. The impression was that the former are slightly better off and that has been reflected in their marginally higher match rates as well; but given the diverse backgrounds of the whole brand of “IMGs”, it is a difficult (and possibly biased) endeavour to classify them all under one statistical umbrella; but there is no way out and hence this generalisation will have to be accepted for all its flaws.

The overall PPA has stayed fixed at 0.77 for the past three years, which as 0.75 (the lowest ever) the two years preceding that. The fact that despite the addition of almost 3000 extra positions this year thanks to expansion of programs, and more so due to the all in principle, this should have seen a sharp spike. The fact that it did not points to the issue that the competition is growing more intense each year. Let us see how the IMGs have fared overall, in comparison to the US grads and overall picture. For the analyses from here onwards, I shall majorly restrict myself to the past 5 years as that is the time frame with the complete data set in the report:

PPA of US Seniors, All participants and IMGs combined
PPA of US Seniors, All participants and IMGs combined

ppa_usa is the PPA for the AMGs, ppa_overall is the PPA for all active applicants and ppa_img is the PPA for the IMGs combined.

So we see that the PPA has risen sharply both for the IMGs and the AMGs but have not been changing overall. The only way I can account for the discrepancy is that there has been a concomitant increase in the osteopathic and other candidates (US Seniors, Canadian, fifth pathway), which has accounted for the stagnation of the PPA despite a fresh influx of positions that has bumped the numbers for both IMGs and AMGs.

In order to arrive at the PPA for IMGs, I assumed that all AMGs, Osteopathic students, 5th Pathway applicants, US Seniors and Canadian students would match ahead of the IMGs. While this is definitely not a reflection of reality where a lot of IMGs give the AMGs a run for their money, I believe while assessing our possible futures, it is better to play safe with pessimistic numbers.  So, I deducted all the seats consumed by the matched groups to come up with the IMG PPA metric.

Further, in order to understand whether US IMGs fared better than non-US IMGs, I further split up the data for the IMGs, working on the principle that US citizen IMGs would match ahead of the others. So, comparing these two groups, we see:


ppa_usimg is the PPA for US Citizen IMGs and ppa_net_img is the PPA for non-US Citizen IMGs.

As the numbers for the true IMGs (please do not take it the wrong way) emerge, we see the wide gulf that separates the IMGs from the other groups. The smaller number of US Citizen IMGs is probably responsible for the rather high PPAs. Notably, though US IMGs have a slightly better match rate (in the 50% zone) than the IMGs overall (around the 40-42% zone), the numbers are starting to look up. Though I assumed that the US IMGs would match ahead of the non-US IMGs, and the data does show a slight trend to that effect, for all practical purposes, in terms of raw numbers, the difference is hardly worth noticing. Here is a table that depicts the match rates over time:

Match Rates of Different Classes of Applicants Over Time
Match Rates of Different Classes of Applicants Over Time

So, to come to the TL;DR version of the whole ramble:

  • with the all-in system, numbers all across the board took a big jump as more seats opened up for the applicants
  • AMGs continued to enjoy a good match rate despite the initial fears caused by the widespread reporting of about 1,100 unmatched AMGs, the highest till date
  • AMGs had the highest ever PPA (positions per applicant), 1.51
  • the US citizen IMGs had a slight improvement in PPA, going from 1.40 to 1.42
  • the non-US citizen IMGs also enjoyed the benefits of the all-in system as their PPA jumped from 0.37 (on which it had been stuck for 3 consecutive years) to 0.39. This is still a rather sorry figure
  • despite these subgroups enjoying a higher PPA, the overall PPA stayed stuck at 0.77 for the third consecutive year, which is a slight improvement over the worst-ever figure of 0.75 in the two preceding years. This stagnation can be accounted for by the increase in the numbers of US previous graduates and specially osteopathic students.
  • a record number of students of all types applied for the match this year; and this is set to get only bigger next year. There was a significant increase in the active applicants across board (except for fifth pathway applicants who comprise a very small and rapidly vanishing segment)

With these numbers in mind, I would like to think that this year might be a better match year than before. In fact, considering the amount of seats (1000+) that went into SOAP in 2013 and anecdotal evidence of how people did not want to go with pre-match programs, more programs will decide to go all-in. Applicants are anyways wary of programs that are taking students all-out through the pre-match because of concerns about quality of training and other stuff, and keeping that in mind, more programs are likely to go all in this time. That would mean the highest ever available positions, and the best possible metric for PPA (even with the ever expanding numbers of applicants).

So, if you are a USMLE aspirant and can make it to the end of the road by September, I say go for it, put your name in the hat, statistics might just get you a program!

XKCD: For me it is the USMLE!
XKCD: For me it is the USMLE!

More analyses of the 2013 match stats in an upcoming post!

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

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