21: Looking at the Match Data for General Surgery

Session 21

General Surgery is gaining in popularity, which shows in its competitiveness for residency. You need to be on the top of your game to match. And similar to Internal Medicine, it is the gateway to a lot of subspecialties.

As we're presenting the data here, remember that this is not just for those looking to be general surgeons their whole life but those who are looking into other subspecialties which we will be featuring here on the podcast in the future such as Surgical Oncology, Colorectal Surgery, Surgical Critical Care, Minimally Invasive Surgery, etc. There are certainly a lot of things you can go on and do after your general surgery residency.

The 2017 NRMP Main Match Data is now available since the match happens in March of every year.

[01:45] Total Number of Programs and Applicants

For General Surgery, there are a lot of physicians available with 267 programs around. There are 236 Psychiatry residencies and 204 Pediatric residencies so that gives you an idea that there are more general surgeons than pediatrics. There are 241 OB/GYN residencies so there are a lot of surgical residencies.

General Surgery has two categorical residency programs. A categorical program is one where you apply to the program from medical school and that's where you're going to do your five years of General Surgery residency. Then there are prelim surgery positions and there are more prelim surgery positions than there are categorical.

Somebody doing a surgical prelim can do it because they're going into a surgical subspecialty straight out of medical school and they're required to do their PGY-1 year separate from their categorical residency.  In this episode, I will only tackle the full five-year categorical surgery programs consisting with 267 programs for categorical surgery.

Out of 267 programs, there are 1,281 spots. There are almost 5 spots at each program. Interestingly, there are not a ton of U.S. Seniors applying for these categorical programs. And out of these spots, there were only 1,383 that applied and 2,388 total applicants. For the purposes of this data, U.S. Seniors equals Seniors at an allopathic (MD) medical school. Hence, this does not include graduates of an MD medical school. These are only students who are still in school. Those who took some time off to do some research or didn't match the first time are not included in the U.S. Seniors data. There were 3 unfilled programs which means a lot of of people are matching with 99.6% of the spots filled.

I want to briefly mention that if you don't match in a categorical spot, it's typically pretty easy to do a Supplemental Offer and Acceptance Program (SOAP), which used to be called Scramble. There are only 61.7% of those spots were filled. So it's very easy to do a SOAP into a program if you don't match in a surgical program.

But assuming your stats are decent and you're a good person, you're probably going to match because it's not overly competitive for U.S. Seniors which is interesting.

[06:55] Types of Applicants

Table 2 of the 2017 NRMP Match Data breaks down the types of applicants for each specialty. For categorical surgery, there were 1,281 positions and there were 1,276 were filled. So there were 5 empty spots and 3 programs that went unfilled.

Out of the 1,276 filled positions, 1,005 were U.S. Seniors while 74 were U.S. Grads (students that either didn't match the first time or didn't apply because they were doing research or something else. Total number of U.S. Seniors (allopathic MD students) was 1,079 out of the 1,276 positions. The rest of it was filled by 64 osteopathic students and 62 U.S. International medical graduates.

Something that is highly debated in the premed world is whether to go to a U.S. DO school or an international MD school, specifically Caribbean schools. If General Surgery is something you're interested in, there were 64 students that matched from U.S. osteopathic schools and 62 from international medical schools.

Moving along, there were 71 Non-U.S. International medical graduates that matched into General Surgery. For me, this is a peculiar number and is not something I would have thought to see. It just goes to show that there is still a high demand for General Surgery spots so they're taking as many possible and the most qualified and a lot of those happen to be non-U.S. citizen international medical graduates.

[09:47] Trends in Positions Offered and U.S Seniors (2013-2017)

Table 3 of the 2017 NRMP Match Data illustrates the total number of physicians offered from 2013 to 2017.

This is the fourth time I've looked at the Match Data and the numbers always seem to very consistent. Surgery is no different at 4.4 to 4.5 every year, going at a a good, steady pace and hopefully it continues that way.

Table 7 shows the number of U.S. Seniors being accepted compared to all applicants over the course of the last five years. As the number of seats in each program has increased all the way up to 1,281 for 2017, the U.S. Seniors are increasing as well. This is a good thing in that more U.S. allopathic students are going into General Surgery to fill this increasing need for spots. It's not necessarily a good thing for DO students or U.S. International medical grads because the demand is rising among U.S. Seniors as there are more spots.

Table 8 shows the actual percentage of U.S. Seniors for each of the programs. There were 80.8% of U.S. Seniors in 2013 and it dropped down to 76.5% in 2014, back up to 80% in 2015, back down to 76.4% in 2016, and then up again at 78.5% in 2017. This suggests that maybe the demand is not as high also looking at the data in table 7.

Table 9 shows the percentage of applicants that matched into a given field compared to the rest as a whole. 4.6% of all applicants that matched in all fields matched into Surgery (categorical). So it's up there. Internal Medicine is huge at 25.6%, Family Medicine at 11.6%, Emergency Medicine at 7.4%. This gives you an idea of where Surgery lies. Interestingly, Psychiatry (categorical) is at 5.4% which is more than Surgery and Pediatrics at 9.7%.

[13:25] Osteopathic Students, Unmatched U.S. Seniors, Independent Applicants, and SOAP

Table 11 looks specifically at Osteopathic students who have matched into PGY-1 spots as a whole. This is similar to the last table but this one looks specifically at osteopathic students. As expected, General Surgery has a lot less total number of osteopathic students percentage-wise. Looking at all specialties adding up to 100%, Surgery only made up 2.2% of all osteopathic students that matched into an allopathic General Surgery (categorical) program.

Students may think it's harder to go to an MD General Surgery residency as a DO student and if this is what they want to do, then they should probably only apply to MD programs. My different perspective on this is that if osteopathic schools are doing a good job at recruiting students that meet this "osteopathic" philosophy and are looking at recruiting and attracting more students that are interested in Primary Care, then there should obviously be a lot less that are matching into a surgical program.

Figure 6 of the 2017 NRMP Match Data shows the percentages of Unmatched U.S. Seniors and Independent Applicants (outside of the U.S. Seniors which, for these purposes, are considered U.S. allopathic students who are still in school). General Surgery had one of the higher unmatched rate at 20.7%, which is 9th on the list. Majority of those are unmatched, independent applicants (non allopathic students, non MD Seniors). The unmatched U.S. Seniors was only 9.6%. This is still high compared to a lot of the other specialties. It seems it's getting more and more competitive and this is a trend that I've heard from speaking to others that General Surgery is becoming more and more competitive as there are more options available for these subspecialties and fellowships afterwards.

Table 18 breaks down the SOAP process and looking into Surgery (categorical), there were 3 programs that needed to fill 5 spots and all 3 programs filled those 5 spots through the SOAP process.

Looking at the National Matching Service Data for 2016 for the different program types, there were 49 programs for General Surgery for osteopathic students and 155 positions. 149 positions were filled and 6 went unfilled.

The data given is not as robust at the NRMP so I'm uncertain if there were a lot more applicants than these 155 spots and a lot went unmatched or if there weren't just that many applicants.

[17:43] 2016 Charting the Outcomes - NRMP

Based on the 2016 Charting the Outcomes for the NRMP, Chart 3 shows the match rates and there was an 83% match rate for U.S. Allopathic Seniors for General Surgery. Looking at other specialties, Dermatology at 77%, Neurosurgery at 76%, Orthopedics at 75%, Plastic Surgery at 77%, and Vascular Surgery at 71%. So General Surgery is right there with all of the other surgery subspecialties.

Chart 4 shows the Median Number of Contiguous Ranks of U.S. Allopathic Seniors. For students that matched and those who didn't, the chart shows you how many programs they ranked on their rank list when they submitted. Those that matched ranked 13 as a median number while those that did not match ranked 5. If you are picky about where you go or if you didn't get an opportunity to apply or to interview at a lot of spots, then you have a lot less chance of matching.

Chart 12 shows the percentage of U.S. Allopathic Seniors who are members of AOA (the Honor Society for medical students showing good academic success in medical school). For those that matched only 17% of the U.S. allopathic Seniors were AOA whereas 52% for Plastic Surgery and 53% for Dermatology. So General Surgery is in the lower end for a surgical specialty.

Looking at the Summary Statistics (Table GS-1) for General Surgery, those that matched have a decent Step-1 Score at 235 and those that did not match at 218, which shows a big difference in Step scores. This is one of those things where you need to be very realistic with your chances of matching. If you don't match, why? Could it be that because your Step score is not high enough? The mean Step 2 score is 247 for those that matched and 231 for those that did not.

[21:20] Burnout, Happiness, and Compensation

The Medscape Lifestyle Report 2017 and Medscape Physician Compensation Report 2017 are two separate reports that Medscape releases every year.

For the Lifestyle Report, more than 14,000 physicians over 30 specialties have responded in the survey. The numbers are not necessarily the best data-wise because it's a survey so just take this with a grain of salt.

Who is the most burned out? General Surgery is lower on the list at 49% which is more than halfway down the list. This is good. But looking at how severe is the burnout, surgery is higher up on the list at 4.3 from a scale of 0-4.5.

Which physicians are happiest at work and outside of work? General Surgery is higher up on the list with 35% happiness at work and 69% happiness outside of work. So it's on the higher end of the scale.

Moving on to the Medscape Physician Compensation Report 2017, General Surgery is higher up on the list with an average annual salary of $352,000. Above it is Anesthesiology and below it is Ophthalmology. So it's a decent living as a general surgeon. Although if you think about the lifestyle and everything else, it's harder. So you're compensated for that harder lifestyle.

Looking at the rate of increase year over year,General Surgery had a 9% increase which is pretty decent. The number of physicians who feel fairly compensated for General Surgery is lower at only 48%.

Whether a specialist would choose medicine again, General Surgery is right in the middle at 77%. While only 82% said they would choose the same specialty, which is a little in the lower half of all the specialties there.

[24:50] Final Thoughts

If you're not sure what you're interested in yet, go through these numbers. It's eye-opening to see what is going on in the world when it comes to matching and physicians that are happy and making money and those that aren't.

Links:

MedEd Media Network

2016 Match Data NRMP

Supplemental Offer and Acceptance Program (SOAP)

National Matching Service Data for 2016

Charting the Outcomes - NRMP Medscape Lifestyle Report 2017

Medscape Physician Compensation Report 2017

AOA