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) |
Applicants who selected "Prefer not to answer" or "I do not know" disability status were excluded from analysis.
Includes combined specialties.
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 |
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.
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.
Data Sharing Statement
References
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Data Sharing Statement