Match rates into higher-income, controllable lifestyle specialties for students from highly ranked, research-based medical schools compared with other applicants

Abstract

Background: Factors impacting medical student specialty career choice are poorly understood, but may include income potential and lifestyle features such as limited and predictable work hours.

Methods: Data from the National Resident Matching Program and the San Francisco Match were used to examine match rates into higher-income controllable lifestyle (CL), lower-income CL, and noncontrollable lifestyle (NCL) specialties from 2002 to 2007. We studied 3 cohorts: students from highly ranked, research-based medical schools, other US senior medical students, and independent applicants (consisting mostly of graduates from foreign medical schools).

Results: By 2007, 22.5% of students from highly ranked schools matched into a higher-income CL specialty compared with 16.5% of other US seniors and 8.4% of independent applicants. During the study period, students from highly ranked schools increased their match rate in higher-income CL specialties by 7.9%, while all cohorts experienced declines in match rates for NCL specialties. Compared with other US seniors, students from highly ranked schools were more likely to match into higher-income CL specialties (odds ratio [OR], 1.46; 95% confidence interval [CI]: 1.27-1.68), while independent applicants were much less likely to do so (OR, 0.46; 95% CI: 0.42-0.51). Independent applicants had the highest odds (OR, 2.38; 95% CI: 2.25-2.52) of matching into NCL specialties.

Conclusions: All cohorts had declining match rates into NCL specialties from 2002 to 2007. When compared with other US seniors, students from highly ranked schools had the highest odds of matching in higher-income CL specialties, while independent applicants had the highest odds of matching into NCL specialties. These trends are important to consider in light of recent efforts to better balance the physician workforce.

Figure 1

Relative Change in Match Rate From 2002–2004 to 2005–2007 Pooled match rates among students from highly ranked schools, US seniors, and independent applicants during the first and second half of the study period for higher-income controllable lifestyle, lower-income controllable lifestyle, and primary care specialties. Statistical significance for the change over time is indicated by ^a for P < .05 and ^b for P < .01.

Figure 2

Odds of Matching Into a Specialty Compared With US Seniors, 2007 Odds ratios and 95% confidence intervals for students from highly ranked schools and independent applicants matching into higher-income controllable lifestyle, lower-income controllable lifestyle, and primary care specialties, relative to US seniors.