April 2013




Chief medical editor's corner of the world

Finding future ophthalmologists: The match game

by Cindy Sebrell ASCRS•ASOA Director of Public Affairs

One of the most difficult and yet important tasks for academic ophthalmology programs is the selection of residents. Outside of academia, all of us should have an interest in the process because it eventually determines who will become our professional peers and who will lead our specialty forward into the future. The good news is that ophthalmology continues to attract some of the top medical students, and the quality of the applicant pool continues to be strong. The fact that there are so many more qualified applicants than available positions makes this process especially difficult for most program directors. I was stunned to learn that the average applicant applies to 58 ophthalmology programsmore than half of the total number of ophthalmology programs in the country. Wow.

Ayman Naseri, MD, is the residency program director at University of California, San Francisco (UCSF), and oversaw a large study on predictors of residency acceptance that is published this month in Ophthalmology. The study evaluated more than 3,400 applicants over a seven-year period and seems to confirm the importance of medical school reputation and quantitative criteria such as test scores. It was interesting to learn that the majority of applicants matched at a residency program from the same geographic region as their medical school.

This month, I asked Dr. Naseri about the findings of this study, their significance, and about overall trends in the residency application pool and process. I also asked another residency director, EyeWorld editorial board member Steven Gedde, MD, to comment on the paper.

David F. Chang, MD, chief medical editor



Dr. Naseri (right) attends a resident cataract operation by UCSF resident Dr. Michael Seider. Source: Ayman Naseri, MD

Ayman Naseri, MD

Dr. Chang: Is the overall number of U.S. ophthalmology residency applicants rising or falling?

Dr. Naseri: In contrast to the rising number of medical school graduates, the number of applicants in ophthalmology has been falling fairly steadily since 1999. In fact, the data for the most recent match shows that we had a smaller number of applicants to ophthalmology in 2013 than in any year since the 1980s. Compared to the data from the 1999 match, there has been a 19% reduction in the number of applicants, despite an increase in the number of spots available. I do not intend to be an alarmist, but the trend may be concerning to some.

It is odd that despite this trend, applicants feel compelled to apply to more and more programs. In fact, the average number of applications per applicant has gone from 38 in 2003 to 58 in 2013, an increase of more than 50%. Because of this, it may be that individual programs are seeing a similar number of applications to their specific program despite the decreasing number of total applicants to ophthalmology. I am hopeful that our study may shed some light on the match outcomes so that the process can become more efficient.

Dr. Chang: What percentage of medical students wanting to enter ophthalmology gain acceptance into a U.S. residency? How difficult is this compared to other medical specialties?

Dr. Naseri: If you look at all applicants together, the 2013 match rate was 67%, compared to a match rate in 1999 of 51%. If you separate U.S. medical students from foreign medical graduates, you would expect the match rates to be quite different. In our study reviewing the match outcomes between 2003 and 2008, the match rate for U.S. graduates was 72%, while the match rate for international graduates was 15%. Although it is difficult to do a direct "apples to apples" comparison, the match rate for ophthalmology appears similar to the match rates for radiology, orthopedic surgery, dermatology, and otolaryngology, based on National Residency Matching Program data. Ophthalmology is less competitive than plastic surgery whose 2011 match rate was only 44% for U.S. seniors. Ophthalmology is still much more competitive than many specialties such as internal medicine, pediatrics, and neurology.

Dr. Chang: Why did you decide to undertake this study?

Dr. Naseri: For many applicants the match process is an opaque and anxiety-provoking experience. It was our goal to provide some transparency about the match and to provide data to support applicants' decision-making. For medical student applicants and their advisors, we are hopeful that the results of this study will help guide them in determining how many applications to submit, how many interviews to go on, and the overall strengths and weaknesses of their application relative to others in the applicant pool. This project was really driven by the curiosity and enthusiasm of one of our residents, Allison Loh, MD, whose own experience with the match process was still fresh in her mind. She deserves the credit for inspiring the rest of her co-authors.

Dr. Chang: What factors had the highest correlation with acceptance into a residency program?

Dr. Naseri: In multivariate logistic regression, the factor that was the strongest predictor of matching was attendance at an allopathic medical school (versus osteopathic). After that, the strongest predictors of matching were AOA membership, attendance at a top medical school, and attendance at a medical school with an ophthalmology residency. USMLE score was also a powerful predictor of matching; each 10-point increase in USMLE score conferred an almost 60% increase in the probability of matching successfully.

Dr. Chang: Do you think that the apparent importance of medical school ranking/reputation is justified?

Dr. Naseri: Others have pointed out that some of the most important characteristics in the resident selection process are difficult to determine from an application form or interview: compassion, integrity, critical thinking, passion, respect for others, etc. Since we struggle to identify and measure these non-cognitive variables, many of us lean on quantitative, cognitive metrics. Grades, board scores, and educational pedigree fall into that category. If we could accurately determine these non-cognitive attributes, I suspect that the influence of variables like medical school reputation would be mitigated. This is at the heart of what makes the process so challenging.

Dr. Chang: What findings surprised you the most?

Dr. Naseri: While it might have been intuitive that geography would play some role, I was surprised by the magnitude of the effect of geography on the match. Nearly 60% of applicants matched in the same geographic region as their medical school. Applicants from the South and West regions were almost four-fold more likely to match in their same region as in another region. And I think our study underestimates the effect of geography since we only looked at medical school location. If one were to look at applicants' hometowns or undergraduate institutions, I suspect the effect would have been even greater. It was also interesting to find that the applicants most likely to match outside of their region were those with higher USMLE scores and those from a top 10 medical school. In conclusion, we are hopeful that the findings from this study will help guide applicants and their mentors as they navigate the stressful process of selecting the next generation of U.S. ophthalmologists. Personally, I am hopeful that this information will also assist in mitigating some of the inefficiencies of the match process.

Contact information

Naseri: Ayman.Naseri@va.gov

Finding future ophthalmologists: The match game Finding future ophthalmologists: The match game
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