I have pretty much been declared the official (Indian) USMLE rumor-monger by one of the most famous USMLE coaching institutes that held introductory classes to tell the masses what USMLE was all about. Thank you sir, you made my day.

Now, again, another disclaimer. The last time I wrote about the USMLE match (this one: The USA Dream for IMGs: Coming to an end? Analyzing the 2012 Match) I received a lot of hate mail and comments telling me, pretty much, to buzz off. Hence this time, before launching into my tirade, I shall dwell on this paragraph a while longer. I am NOT trying to dissuade anyone. I am NOT spreading rumors. I am simply trying to analyze the numbers being given out by the authorities in charge of the system and trying to interpret them within the limits of my intellectual and academic abilities. I may well be wrong, so please do not take my word to be sacred, and end up bashing me or praising me. I am just following the logical train of thought that I can construct. Where it leads me to is not in my control. Also, whatever I am writing is MY understanding of a very complicated system. And it maybe entirely WRONG. If it is, let me know, I shall make the required edits.

Ok. So then, down to the brass tacks.

The NRMP has not yet come up with the detailed analysis and numbers yet – another couple of months for that – but they have released an advanced report and press releases that have quite a lot about the IMGs, which specifically is my area of interest. You can read the whole thing over at the ECFMG Reporter.

Before I start with the number crunching, let me first make sure you all have heard of this new thing this year, called the “all-in system”. Till the last year’s match, programs were not compelled to fill all their seats through the Match. Now before you start shoving knives into my throat let me explain. This meant that the programs could fill in seats through systems beyond the match. Pre-match offers, for example. This year, to ensure that there was a more level playing field and more or less uniform judgment of all applicants, the NRMP declared that programs had to go all-in or all-out. That means, they had to declare that they were going to fill ALL their slots either through the Match or through other non-match routes. No more walking the dual path. And although it is not yet clear how many programs chose to be all-out (hopefully, the NRMP will come out with that data when the publish the detailed numbers for this year’s match), it is only reasonable to assume that most programs would have opted to go for filling residency slots through the match. So, do not let the higher numbers fool you into believing that the future is rosy. In fact, the ECFMG Reporter reports:

This policy is a factor in the higher numbers, compared to last year, of both positions offered through the 2013 Match (up 2,358 or 9.8%) and the number of IMGs participating in the 2013 Match (up 1,549 or 13.9%). It also, presumably, reduced the number of positions available outside of the 2013 Match.

Now, what that means is that there were more seats to deal with in the Match this time around than any of the previous years. So, whenever you see a spike in this year’s numbers, keep in mind that they might have been because of this newly placed policy rather than because of an increase in scope. I am not denying there is an increase in scope. There possibly is. But until and unless the end-of-the-year data for 2012 match is released, we cannot say that for sure. For the purposes of this post, I shall stick to the numbers from 2011 match for data whenever the ones from 2012 are not available or are incomplete.

	2013	2012	Change
Total Residency Slots available	26,392	24,034	+2,358 (9.8%)
IMGs Participating	12,683	11,107	+1,576 (14.2%)
IMGs Matched (US+Non-US)	6,311 (49.8%)	4,886 (43.9%)	+1425
Non-US IMG Applicants	7,568	6,835	+733 (10.7%)
Non-US IMGs Matched	3,601 (47.6%)	2,775 (40.6%)	+826
US IMG Applicants	5,095	4,281	814 (19%)
US IMGs Matched	2,706 (53.1%)	2102 (49.1%)	+604

These numbers are all very rosy, until you take a look at the situation that eventually transpires when the non-match candidates are chucked into the equation. For this purpose, we shall cast a glance on the 2011 numbers, In the 2011 match:

Positions filled by IMGS through Match = 4,626

Total IMGs entering PGY-1 for the year 2011-12= 6,754

Thus IMGs entering by non-Match routes= 2,128

So, in 2011, almost a third (31.5%) of the positions filled by IMGs were filled through non-Match routes.

Though I do not have the US/Non-US break up for this number, yet, this seems like a pretty serious bit of statistics to me. And, if you notice, the eventual number of IMGs matching into the system in 2011-12 was much more than those that matched in the match in 2012-13 and even the all-in system of 2013-14, So if you are an IMG who managed to snag a position this year, well, that’s a pretty darn good job. Give yourself a pat on the back.

Mean times, if you, fellow student, are traveling the arduous journey along the path of USMLE, well, if you want to attain nirvana, hurry up. Otherwise, the journey may end in a cul-de-sac!

Yes, the numbers this year may still be a bit higher than what has been reported, but since not many programs would have opted to go all-out, it is unlikely that the bump would be significantly large.

So, in conclusion,the following stand out:

1. There has been a large spike in the proportion of non-US IMGs matching into PGY1 positions this year, but how much of it is attributable to the all-in system needs to be factored in before jumping with joy.

2. The rate at which the IMGs are applying is fast outstripping the rate at which the positions are increasing. Even with the all-in system in place, the growth difference this year was about 4%, which is a pretty steep climb.

3. Another metric that is of utmost importance is the positions/applicant ratio. This metric was 0.77 overall last year and 0.91 for US Seniors. In comparison, this year, the positions/IMG applicant is 2 and for non-US IMGs, it is 2.1. Although this is much better than any odds you may face in India, this is not very hot as compared to the other years in the USMLE history!

4. The rates of US-IMGs matching into PGY1 positions is also increasing, as expected. And this year, there was a major spike in the number of US-IMGs applying for Residency. As US medical education remains unacceptably, and often, unaffordably expensive, more and more US students will see it fit to gather their undergraduate degree from one of the developing world countries, where they can get by wit a fraction of the 300,000$ they would otherwise may have been burdened with. As this trend continues, it shall spell more pain for the IMGs. The way I see it, and I may be wrong, is that, any program will be happy to accept an American applicant over an International Grad who may have slightly superior credentials than his US colleague. The fact that they would not present a diplomatic difficulty, what with Visa and other laws changing every year in different countries, is indeed a tempting proposition.

Bottomline, USMLE still seems like a better bet, at least numerically speaking than the Indian PG exams. However, you need to factor in the costs, the time and the rapidly shrinking opportunities (as compared to the previous years) before you make this apples-oranges comparison.

And if you are a USMLE aspirant, I wish you all the best, and hope you shall not be dissuaded by this post simply because the numbers-gradient is fast becoming steeper.

Post-Script:

Several friends of mine have matched into the PGY1 positions this year. And none of them will say that the process was without pain or heartache or headache. It just comes with the terrain. My intentions in writing these USMLE series of posts is NOT to discourage people, but to make them understand the risks, as I understand them, before they take this very expensive, very time-consuming leap. This also feeds my interest in Medical Education, because this is an extraordinarily transparent and open system which lends itself to analysis (and criticism), as far as the outcomes are concerned. We all know the great mystery of the USMLE scores and interviews process, so no comments on that!!!

I only wish that the Indian PG entrance system gets streamlined lends itself to a similar vein of accountability, and I believe that instituting the NEET-PG, a unified entrance exam for Post-Graduate Medical Education in India is the right formula to that end.

So, friends, whether or not you are a doctor/medical student/PG aspirant/USMLEan, follow nd support the #saveNEETPG movement on your social circles. Thanks.

Now you may post your blasting of my thoughts again. Or if you want to stay anonymous, use the contact form on my contact page.

Image Credits: First one, Fizzzy. Second one: Random Facebook share.