Bates et al. recently described the 2019 National Residency Matching Program (NRMP) Match results for radiation oncology (RO), noting that the 14.5% unmatched rate was six-times higher than the average rate (2.5%) over the last 8 years.1 Many have listed a free market response as a possible (and preferable)2 reaction to RO workforce imbalances.3–6 Some may interpret the 2019 Match as evidence of a simple market correction to the anticipated oversupply of ROs7 - that declining medical student interest in the field will result in a reduction in the absolute number of RO trainees per year via unmatched positions.
We urge caution interpreting the Match results as such. Rather, we suggest the following as plausible. That the increased unmatched rate will not yet be accompanied by a proportional decrease in the number of graduating trainees for two reasons:
The unfilled spots may be filled via the post-Match Supplemental Offer and Acceptance Program (SOAP) or other means.
The absolute number of available (and filled) positions continues to rise.
Of the 30 unfilled positions in the 2019 Match, 19 of 27 available in the SOAP filled.8 As a result, the total number of RO positions filled through the Match or SOAP rose from 192 (of 193 available positions) in 2018 to 196 (of 207 available positions in 2019), continuing the trend in increased spots per year (Table 1). Indeed, the realized post-SOAP unfilled rate was 5.3%. Spots may also be filled outside of the Match to international medical graduates or residents switching specialties.9 It is unknown how many of the 11 positions that did not participate in or fill via the SOAP ultimately filled.
Table 1.
| Match | SOAP | Total Filled Post-SOAP | Unfilled Post-SOAP | Realized Unfilled Rate Post-SOAP | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Available Positions | Filled | Unmatched Positions | Unfilled Rate | Available Positions | Filled Positions | |||||
| 2018 | PGY1 | 16 | 15 | 1 | 3.1% | 1 | 1 | 16 | 0 | 0.5% |
| PGY2 | 177 | 172 | 5 | 4 | 4 | 176 | 1 | |||
| Total | 193 | 187 | 6 | 5 | 5 | 192 | 1 | |||
| 2019 | PGY1 | 15 | 14 | 1 | 14.5% | 1 | 1 | 15 | 0 | 5.3% |
| PGY2 | 192 | 163 | 29 | 26 | 18 | 181 | 11 | |||
| Total | 207 | 177 | 30 | 27 | 19 | 196 | 11 | |||
Does not include positions filled outside of the Match or SOAP.
RO remains a highly desirable specialty in terms of lifestyle (e.g. minimal call burden), compensation, and (in our opinion) rewarding and intellectually stimulating work (e.g. curing cancer with radiation) relative to many specialties. As the barrier to entry is lowered, it is plausible RO becomes an appealing “back up specialty” for those considering competitive specialties, or be considered by previously uncompetitive candidates. So long as the absolute number of available positions remains elevated, and alternate pathways for RO entry exist (e.g. SOAP), the validity of rapid free market-based solutions to RO workforce imbalances will be tested.
References
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