Fewer MD but More DO Seniors Match to Family Medicine in Record-breaking 2019 Match

Congratulations to the Incoming Class of Family Medicine Residents

At 12 pm on March 15, thousands of graduating medical school seniors eagerly, in unison, and undoubtedly with a flutter of apprehension and tremendous excitement opened their Match Day envelopes during medical school celebrations to learn which residency program will be their training ground beginning in July.

The Match, formally known as the National Resident Matching Program (NRMP) Main Residency Match, is the pinnacle of the near year-long process that matches fourth-year medical students’ residency placement preferences with those of residency program directors.

Joyful, privileged, and anxious are words Sanjiv Kandiah, 2019 MD candidate at Oakland University William Beaumont School of Medicine, used to describe how he felt moments before learning he matched to Beaumont Health Troy Family Medicine Residency.

"I feel very grateful to have matched at the Beaumont Health Troy Family Medicine Program. I completed part of my third-year clerkship at Beaumont Hospital, Troy and had a pleasant experience. This encouraged me to further pursue a sub-internship there in my fourth year, where I completed a four-week inpatient rotation with the Family Medicine team. I was trusted with more responsibilities and was valued as a contributing member of the team. I felt the resident physicians, faculty and staff I worked with were very supportive and respectful. Although I know that the training here will be rigorous, I am excited to work with these wonderful people again over the next several years!" he said.

A native of Toronto, Sanjiv holds a Master’s in Global Health and previously worked as a medical assistant at a Family Medicine clinic. Through these experiences, combined with exploring other specialties during medical school, Sanjiv said he was drawn to Family Medicine because it requires a wide breadth of knowledge to care for patients traversing all ages and disease burdens. This, he said, creates a challenge and stimulus for lifelong learning, which inspire him.

“I will likely learn something novel on a daily basis and be able to utilize that to make an impact on patients’ lives.”

Addressing the PCP Shortage, One Resident at a Time

This year's Match was the largest on record. While state- and program-specific numbers have not yet been published, NRMP reports that Family Medicine residency programs nationwide offered a combined total of 4,107 positions—478 more than in 2018. Of those, 93.2% (3,827) were filled and 39% (1,601) were filled with U.S. allopathic seniors. This is the first year since 2009, however, that the number of U.S. allopathic seniors matching to Family Medicine decreased. Conversely, a record number of 986 osteopathic students and graduates matched to the specialty, accounting for a 25.8% of all applicants who matched to Family Medicine. 

“With a projected deficit of 52,000 primary care physicians in the U.S. by 2025, it is critical that the number of medical students choosing primary care specialties, particularly Family Medicine, increase every year,” said Mary Marshall, MD, RN, president of Michigan Academy of Family Physicians and a solo Family Medicine doctor in Grand Blanc.

“The need for primary care will only increase as the large Baby Boomer generation continues to age and more and more physicians are retiring,” she explained. “It's going to take a multi-faceted, multi-stakeholder, ongoing effort to achieve the ambitious goal set by AAFP and its partners, of 25% of U.S. allopathic and osteopathic students, combined, choosing Family Medicine by 2030.”

For Tiffani Strickland and Alec Ludwig—graduating seniors at Wayne State University School of Medicine and Michigan State University College of Osteopathic Medicine, respectively—choosing Family Medicine grew out of their desire to provide comprehensive, including obstetric, care that emphasizes prevention. Equally important to them is practicing in an underserved community, providing care to people experiencing homelessness, and building long-term relationships with their patients.

Tiffani recollects that, after shadowing a Family Physician during her senior year in high school, she was impressed with how well the doctor knew her patients and their families, even before walking into the exam room. With this in mind, Tiffani entered medical school thinking that Family Medicine could be the right fit for her. “Could” turned into “would” during her third-year Family Medicine rotation and sub-internship.

“I was able to witness the impact that a trusting relationship can have on patients’ health,” she said. “It was also incredible to see medicine from cradle to grave. My attending on my sub-I delivered a baby, and in the same day, guided an elderly woman into a peaceful death surrounded by loved ones. There really is no other specialty where physicians are able to have this incredible relationship with patients.”

MDs and DOs are a Match

The opportunity to practice full-scope Family Medicine and build relationships across the lifespan are the catalysts for many physicians-in-training—MDs and DOs, alike—choosing Family Medicine as their specialty. Alec, a DO candidate, and Tiffani, an MD candidate, are just one MD-DO match case-in-point. Despite attending different medical schools, they stood side-by-side today as they opened their envelopes to learn they will train together at Sutter Santa Rosa Family Medicine Residency, located 50 miles north of San Francisco. They are among 1,076 couples in this year's Match and among the nearly 77% of U.S. seniors who matched to one of their top three choices.

“We have almost the exact same interests in our future practice of Family Medicine and our vision of the ideal practice settings,” said Alec.

Tiffani echoed this sentiment, adding that, “We are each other’s favorite person and best support system, so couple’s matching was a no-brainer. I am so grateful to be matching with a partner who always emphasized our success as a couple rather than individuals. Open and consistent communication was our strategy from the get-go, and it made the interview trail and rank list enjoyable.”

As allopathic and osteopathic graduate medical education completes, in 2020, the five-year transition to a single accreditation system under the Accreditation Council for Graduate Medical Education (ACGME), most MD and DO seniors seeking residency positions will go through NRMP’s Match beginning next year.

Eighty percent of all osteopathic training programs have transitioned to ACGME accreditation, according to a Feb. 4 American Osteopathic Association news release, and NRMP reported today that 1,036 more osteopathic students/graduates participated in this year's Match than in 2018—that's a 17.1 % increase.

Alec was happy to learn that many programs without osteopaths are open to bringing them on board. In fact, he said, some programs actively recruited DOs during this year’s Match process. For him, being trained in osteopathic manipulative medicine means he will be able to provide another form of care to promote healing for his future patients and help others learn how to do so as well. 

“I’m eager to teach residents and students about this fantastic specialty and how rewarding it is to care for generations of families,” he said. “Additionally, I see Family Medicine as the bridge between policymakers and constituents, and I can’t wait to fill that role. Family Physicians are in the unique position to be [healthcare] experts for our legislators as they craft legislation that affects their constituents.”

Teaching is also a goal of Anne Drolet, who matched to the University of Wisconsin Madison Family Medicine Residency. Post-residency, she plans to pursue a faculty position at a residency program after several years of practicing in a federally qualified health center. While her ideal practice setting is more urban, Anne said she is flexible to wherever she ends up, noting that Michigan is her home and it would be great to practice here.

Like Tiffani, Anne's choice of Family Medicine was solidified during her third-year rotations.

"I knew I was interested and got involved early with Michigan Academy of Family Physicians, but was still torn between obstetrics and Family Medicine. After completing the rotations, I realized I was much happier on my family rotation and loved the large scope of practice. I also received great mentoring from physicians and residents who helped me realize that Family Medicine is the perfect specialty for someone like me who is interested in public health," she said.

The opportunity to be part of Michigan State University's public health program while attending medical school is what drew Anne to the MSU College of Human Medicine. "I loved the focus on community involvement and the public health program was a great complement to my goals."

Community and public health were key considerations for Anne during her residency interviews and ranking process. She said talking to residents at interviews helped her understand how dedicated the programs really are to the underserved.

"I ranked programs higher that seemed to provide rigorous training but still cared about the community. I loved all the programs I interviewed at—they all address different topics of public health and/or different marginalized populations. I'm excited to be part of the Madison community and help patients navigate complex medical issues. I also hope to continue to do research on addressing health disparities and learn more about helping patients with addiction struggles. I'd also love to continue to do low-risk OB care if possible," said Anne.

Preparing for Match 2020 and Beyond

If you are a medical student looking ahead to your match within the next few years, the Academy is here to support you. Both AAFP and MAFP provide opportunities during medical school, as well as residency, to try Family Medicine on for size.

The Match: What Every Student Needs to Know: During this free webinar hosted by AAFP on Wednesday, March 20, at 8-9 pm ET, learn how to navigate the near year-long process, what to look for in a residency program, and tips for making your CV stand out.

National Conference of Family Medicine Residents & Medical Students: This annual conference hosted by AAFP in Kansas City, MO (July 25-27 this year), provides the opportunity to explore the specialty by attending educational sessions and clinical workshops and talking with residents and residency program faculty, coordinators, and directors from Michigan and across the country. Plus, medical student and Family Medicine resident members of MAFP are eligible to apply to represent Michigan as delegates to the National Student or Resident Congress, which convene during the conference. Selected delegates will receive a Family Medicine Foundation of Michigan scholarship of up to $1,000 to help offset conference-related expenses. Applications are being accepted until April 1.

Beyond Clinical & Curriculum: 2019 Family Medicine Resident Conference: This new conference hosted by Family Medicine Foundation of Michigan on Friday, May 10, at Cleary University in Howell, features “business of medicine” sessions on interviewing for your first Family Physician job, understanding the employment contract, making sound financial planning decisions in the midst of student loan debt and everyday expenses, and exploring the diversity of practice settings and how they align with your career and lifestyle goals. Plus, you will have the opportunity to connect with employers who are recruiting Family Physicians in Michigan. Early-bird rates expire on March 29.

Michigan Future of Family Medicine Conference: This must-attend annual event for medical students, being held this year on Saturday, October 13, on the University of Michigan Medical School campus in Ann Arbor, offers hands-on clinical outpatient procedure workshops, a residency program expo, and panel discussions with practicing physicians, residents, and residency program directors and faculty to learn what it's really like to be a Family Doctor. Registration will open at mafp.com/events this summer.

FMFM Medical Student Summer Externship: The goal of Family Medicine Foundation of Michigan's four- to six-week clinical and/or research externship is to stimulate interest in selecting a career as a Family Physician and/or pursuing research opportunities in Family Medicine. So, if you aren't sure if the specialty is for you, work with your medical school to identify a Family Physician mentor who will help you design an externship that meets your interests, and then submit your application by April 1. One student will be selected for the externship, which also includes a $2,000 stipend. This funding is made possible by matching grants from FMFM and AAFP Foundation.

Words of Wisdom

Now that the Match is behind them, Sanjiv, Tiffani, Alec, and Anne offer these words of wisdom that are sure to be helpful for every rising M4, regardless of specialty or MD / DO credentials:

  • Start researching residency programs early on and definitely try to attend a national conference focused on your specialty. The AAFP National Conference is invaluable for networking and exploring residency programs from all over the country.
  • If possible, do an away rotation at the program(s) you like the most. Spending two to four weeks at a program can help you determine if it is really a good fit for you.
  • Request letters of recommendation early and don’t worry about being annoying if you need to nudge the physicians you asked to write letters—they are very busy.
  • Continuously update your CV (or if you don’t have one, put one together ASAP!) to reflect volunteer, work, and research experiences you’ve participated in throughout medical school. This makes it easy to complete the portion of the Electronic Residency Application Service (ERAS) where you must describe the activities you were involved with throughout your collegiate career.
  • Make sure you submit everything to ERAS before residency programs can start viewing your application (that was September 15th for us). That means having your personal statement done, board scores certified, letters of recommendations submitted, and your volunteer/research/work experiences filled out. Also, take advantage of resources your medical school offers to help you through the application, interview, and rank list process!
  • Jot down some notes throughout the day of your interview (and no later!), making sure to mention your general feelings about the program. This will be invaluable after you’ve gone on multiple interviews and begin your rank list process, as the programs can really start to blend together.
  • Send thank you notes within 24-48 hours of each interview. You should send an email to everyone you interviewed with, making sure to personalize each email. For more specifics on what makes a good thank-you note, check out Alec’s recent blog post at tedxoconnell.com.
  • If you are couples matching, apply broadly. For context, Alec and Tiffani—both solid applicants—applied to a little over 40 programs and ended up interviewing at 21 programs.
  • It’s cliché, but the key to a good couple’s match is consistent communication. Tiffani explained: “We were fortunate that we both wanted to go into Family Medicine and, for the most part, we received interviews at all the same programs. (Side note: if only one person gets an interview at a program, it’s okay for that person to inquire about their partner’s application and possibility of an interview. We had a lot of success with this!). After each interview we would chat with each other about our general impression and compare each program against our previous interviews. This gave us a great start to our rank list. With 21 programs, rank lists can get overwhelming, but by comparing each program one-by-one as we went through our interviews, we were able to get through our rank list pretty quickly. If there were any discrepancies with how we felt about a particular program, we would discuss our hesitations and compromise if needed. For example, if I really didn’t like program X and Alec loved it or vice versa, but we both really liked program Y, then program Y ended up higher on our list. The other thing we discussed while making our rank list is how one might feel at a program lower on our list, while the other got a spot at a program higher up. If the person at the program lower on our rank list felt they might resent the person at a program higher up, then we didn’t put that combination. The caveat to this is that the way in which you make your rank list is all dependent on how strong of a candidate you are individually and as a couple. We felt confident enough that we could match together at one of the 21 programs where we interviewed, so we didn’t put every combination of programs possible.”
  • Be yourself during the interview process. If you aren't genuine, you won't find the place you truly match with.