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. 2024 Apr 17;331(18):1590–1592. doi: 10.1001/jama.2024.5000

Outcomes of the Main Residency Match for Applicants With Disability

Mytien Nguyen 1,, Lisa M Meeks 2, Zoie C Sheets 3, Rylee Betchkal 2, Karina Pereira-Lima 4, Christopher J Moreland 5, Dowin H Boatright 6
PMCID: PMC11024793  PMID: 38630504

Abstract

This cohort study assesses match rates of US applicants with and without disability into specialty residence programs.


Physicians with disabilities are underrepresented in medical training and face barriers in the training environment.1 A prior study2 found statistically significant inequities in graduate medical education (GME) match rates for other underrepresented groups, such as racial and ethnic minority and low-income applicants. Failure to match into a residency program carries considerable consequences for applicants’ medical careers. Despite commitments by medical associations to increase support for learners with disability in GME, placement rates for US applicants with disability remain unknown. In this cohort study, we assessed match rates by applicant disability status.

Methods

Data on the main residency match outcomes by specialty were retrieved from the National Resident Matching Program for all applicants applying in 2022 and 2023, including MD, DO, and international medical graduate applicants.3 Applicants matched through the Supplemental Offer and Acceptance Program were not included. Because data are public, aggregated, and deidentified, per New York University institutional review board (IRB) criteria, the study is not human participants research and does not require IRB approval. Applicants self-reported disability status during match registration by answering the question, “Are you a person with disability?” as previously reported.3,4

We used descriptive statistics to summarize applicant distribution by disability status in each specialty. Differences in match rates by disability status were assessed through Yates-corrected χ2 tests of independence. Statistical significance was 2-sided with P < .05, Bonferroni corrected for multiple comparisons. Analyses were performed using GraphPad Prism v10 (Dotmatics, LLC). This study followed the STROBE reporting guideline.

Results

In 2022 and 2023, 4115 of 69 761 applicants (5.9%) registered for the match self-reported as having a disability. The highest proportions of applicants reporting disability were in the specialties of psychiatry (10.9%), medicine/pediatrics (9.2%), child neurology (8.9%), and emergency medicine (8.8%). The lowest proportion of applicants reporting disability occurred in the specialties of internal medicine (3.1%), diagnostic radiology (4.6%), otolaryngology (4.5%), anesthesiology (4.9%), and dermatology (4.9%) (Table 1).

Table 1. Characteristics of 2022 and 2023 Applicants to the Main Residency Match by Self-Reported Disability Statusa.

Specialty Disability status, No. (%)
Yes No
Psychiatryb 447 (10.9) 3657 (89.1)
Other specialtiesc 266 (10.4) 2304 (89.6)
Medicine/pediatrics 66 (9.2) 648 (90.8)
Child neurology 28 (8.9) 285 (91.1)
Emergency medicineb 387 (8.8) 4018 (91.2)
General surgery 332 (7.5) 4087 (92.5)
Pediatricsb 385 (7.0) 5135 (93.0)
Family medicineb 524 (6.7) 7284 (93.3)
Physical medicine and rehabilitation 78 (6.7) 1080 (93.3)
Obstetrics and gynecology 211 (6.1) 3265 (93.9)
All 4114 (5.9) 65 647 (94.1)
Orthopedic surgery 139 (5.9) 2218 (94.1)
Neurology 114 (5.4) 1992 (94.6)
Pathology 71 (5.2) 1317 (94.8)
Anesthesiology 215 (4.9) 4167 (95.1)
Dermatology 63 (4.9) 1210 (95.1)
Diagnostic radiology 122 (4.6) 2527 (95.4)
Otolaryngology 39 (4.5) 826 (95.5)
Internal medicineb 623 (3.1) 19 618 (96.9)
a

Applicants who selected "Prefer not to answer" or "I do not know" disability status were excluded from analysis.

b

Includes combined specialties.

c

Other specialties include 6 specialties that had insufficient number of applicants with disability for disaggregated data reporting. These specialties include interventional radiology, neurosurgery, plastic surgery, radiation oncology, thoracic surgery, vascular surgery, and transitional year.

Applicants reporting disability had a lower match rate compared with applicants not reporting disability (81.8% vs 83.2%; difference: −1.4% [95% CI, −2.6% to –0.1%]; P = .02). Difference in match rate by applicant disability status varied by specialty. Applicants reporting disability had significantly lower match rates compared with applicants not reporting disability in orthopedic surgery (58.6% vs 73.3%; difference: −14.7% [95% CI, −23.0% to –6.3%]; P = .01) and general surgery (65.5% vs 76.2%; difference: −10.7% [95% CI, −15.9% to –5.4%]; P = .001). Applicants reporting disability had significantly higher match rates compared with applicants not reporting disability in otolaryngology (100% vs 82.4%; difference: 17.6% [95% CI, 15.0%-20.1%]; P < .001), neurology (100% vs 83.1%; difference: 16.9% [95% CI, 15.2%-18.5%]; P < .001), physical medicine and rehabilitation (100% vs 86.0%; difference: 14.0% [95% CI, 11.9%-16.0%]; P = .002), dermatology (100% vs 86.4%; difference: 13.6% [95% CI, 11.6%-15.5%]; P = .003), pediatrics (100% vs 92.1%; difference: 7.9% [95% CI, 7.1%-8.6%]; P < .001), internal medicine (86.9% vs 79.6%; difference: 7.3% [95% CI, 4.5%-10.0%]; P = .006), and emergency medicine (86.6% vs 83.8%; difference: 3.3% [95% CI, 2.7%-3.8%]; P < .001) (Table 2).

Table 2. Match Outcomes for 2022 and 2023 Applicants to the Main Residency Match by Self-Reported Disability Status.

Specialty Matched No. (%) for applicantsa Difference in match rate, % (95% CI) Bonferroni-adjusted P value
Reporting disability Reporting no disability
All 3366 (81.8) 54 619 (83.2) −1.4 (−2.6 to −0.1) .02
Orthopedic surgery 82 (58.6) 1626 (73.3) −14.7 (−23.0 to −6.3) .01
General surgery 218 (65.5) 3115 (76.2) −10.7 (−15.9 to −5.4) .001
Diagnostic radiology 94 (77) 2156 (85.3) −8.3 (−15.8 to −0.7) .42
Obstetrics and gynecology 160 (75.8) 2714 (83.1) −7.3 (−13.2 to −1.3) .23
Psychiatryb 344 (76.8) 3036 (83.0) −6.2 (−10.2 to −2.1) .05
Pathology 47 (65.3) 941 (71.4) −6.1 (−17.3 to 5.1) >.99
Anesthesiology 177 (82.3) 3638 (87.3) −5.0 (−10.2 to 0.2) .64
Otolaryngology 39 (100) 681 (82.4) 17.6 (15.0 to 20.1) <.001
Neurology 114 (100) 1656 (83.1) 16.9 (15.2 to 18.5) <.001
Physical medicine and rehabilitation 78 (100) 929 (86.0) 14.0 (11.9 to 16.0) <.001
Dermatology 63 (100) 1046 (86.4) 13.6 (11.6 to 15.5) <.001
Child neurology 28 (100) 259 (90.6) 9.4 (6.0 to 12.7) .003
Pediatricsb 385 (100) 4730 (92.1) 7.9 (7.1 to 8.6) <.001
Internal medicineb 542 (86.9) 15 616 (79.6) 7.3 (4.5 to 10.0) .006
Emergency medicineb 387 (100) 3886 (96.7) 3.3 (2.7 to 3.8) <.001
Family medicineb 454 (86.6) 6104 (83.8) 2.8 (−0.2 to 5.8) >.99
Medicine/pediatrics 66 (100) 648 (100) 0 (0 to 0) >.99
a

Match rates are not available for other specialties (interventional radiology, neurosurgery, plastic surgery, radiation oncology, thoracic surgery, vascular surgery, and transitional year) due to small sample size.

b

Includes combined specialties.

Discussion

Overall, students reporting disability had a small but statistically significantly lower match rate than their peers not reporting disability. In most specialties, match rates were higher or similar for applicants reporting vs not reporting disabilities, but in orthopedic and general surgery, match rates were notably lower. The variation in match rates by specialty among students with a disability warrants further investigation.

Learners with disabilities often face adverse experiences during medical training, are at higher risk of burnout,5 and are counseled away from specific specialties due to stereotyped and restricted beliefs.1 Although the number of medical students reporting disability increased by 112% from 2015 to 2021,4 study findings that applicants reporting disabilities are less likely to match in certain specialties may represent limitations in training opportunities and career advancement for this population.

This study is limited by lack of individual-level data on academic performance, type of disability, race and ethnicity, and medical school type (international, osteopathic, and allopathic). Rates of students reporting disability may vary across these characteristics and may affect match rates. Future studies of specialties with high match rates of applicants reporting disability may identify successful strategies for equitable evaluation and matching for these applicants.

Section Editors: Kristin Walter, MD, and Jody W. Zylke, MD, Deputy Editors; Karen Lasser, MD, Senior Editor.

Supplement 1.

Data Sharing Statement

jama-e245000-s001.pdf (11.9KB, pdf)

References

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

Data Sharing Statement

jama-e245000-s001.pdf (11.9KB, pdf)

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