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The 2022 Orthopaedic Surgery Residency Match Leaves Many Qualified Candidates Unmatched

      Abstract

      Orthopaedic surgery has always been a popular and competitive field, but in 2022, approximately 40% of applicants for orthopaedic surgery residency positions did not successfully match, despite their immense talent and commitment. This is a failure of the system, not the medical student applicants, and there is no evident solution. In fact, the problem is expected to get worse, as many of the approximately 600 unmatched 2022 applicants are expected to apply again next year, further flooding the pool. Reflecting on the results of the 2022 Orthopaedic Surgery Residency Match, we feel incredibly fortunate and humbled to serve as orthopaedic surgeons with a subspecialty interest in Arthroscopy, Arthroscopy Techniques, and Arthroscopy, Sports Medicine, and Rehabilitation.
      “Practice, practice, practice.”–Punchline to a Very Old Joke
      A joke so old we spoiled it by first sharing the punchline, goes something like this: An out-of-town tourist, obviously lost and late to a performance, jumps out of a taxicab in New York City on the corner of 57th Street and Seventh Avenue. He sees a pedestrian, a musician carrying a violin case, passing by on the sidewalk. The tourist runs up to the man and asks, “How do you get to Carnegie Hall?” Without a pause, the weary artist replies, “Practice, practice, practice.”
      The joke comes to mind when one considers the question, “How do you become an orthopaedic surgeon?” The question seems apropos, as orthopaedic surgery is the occupation of most of our readers, and the answers are similar to the old punchline: Study, study, study. Work, work, work. Strive, strive, strive. Focus, focus, focus. Commit, commit, commit. And essentially: Practice, practice, practice.
      What is new, however, based on the results of the 2022 Orthopaedic Surgery Residency Match, is no laughing matter. The old formula of studying, working, striving, focusing, committing, and practicing, each in three portions, is no longer enough. According to Arthroscopy author @randymcohn (aka “Randy M. Cohn, MD, FAAOS, Orthopedic surgeon @northwellhealth … residency … Views are my own.”) on Twitter
      Randymcohn.
      (our source for timely and highly interest-specific information
      • Lubowitz J.H.
      • Provencher M.T.
      • Poehling G.G.
      Follow us on Twitter.
      ): “#orthotwitter here is some data pulled from @TheNRMP#Match2022 for orthopedic surgery: 1,470 applicants for 875 spots (unmatched 40%). M.D. 4th years: 1,086 applicants, 705 matched (35% unmatched). D.O. 4th years: 205 applicants, 111 matched (46% unmatched).”
      Randymcohn.
      For those doing the math, please note that other, smaller categories exist, and please see immediately below.
      Dr. Cohn cites as “source data in case any of my math is wrong,” The Match. National Resident Matching Program. Advance Data Tables: 2022 Main Residency Match.
      As clarified by Arthroscopy author and Editorial Board member, @DrDerekOchiai: “To my non-Twitter followers: this is what #MatchDay2022 actually means. Only 60% of medical school graduates that wanted to do Ortho (were) able to get a spot to train in Ortho. It is highly competitive; it doesn’t end with getting into med school.”
      DrDerekOchiai.
      This is definitely new. According to @randymcohn: “Applications up somewhere around 40% since 2019.” And, according to Arthroscopy author and Editorial Board member, @MichaelAlaiaMD, in “2007 the unmatched rate was like 10-15%.”
      And unfortunately, this may be self-perpetuating: “These numbers are crazy. 600 unmatched students for Ortho??” And, “how many of those almost 600 students who did not match, will be applying next year?” And, “many qualified applicants will funnel into next year’s pool where matters will only worsen. The match rate last year was 70 or 75%. This is not sustainable.” Yet, among “graduates,” or doctors who did not match as 4th year medical students, “…meaning doctors who didn’t match as 4th years and did research years, transitional years, etc.,” only 40 matched. It certainly seems that in the near term, those who don’t succeed in matching to an orthopaedic surgery residency position on their first attempt face long odds of matching in orthopaedics in the future, regardless of the effort they expend in the interim. Nevertheless, it is also likely that many of this year’s approximately 600 unmatched applicants will try again, further flooding the applicant pool.
      Among the other comments on the Twitter thread, many proposed creating more residency spots. “The system continues to produce more #medstudents and not more #residency spots. In the past 3 years we have opened 3 NEW medical schools in Texas alone.” And, “California has at least three new medical schools, none of them with residencies. #scam” This is supported by a 2016 report from the U.S. Department of Health and Human Services (HHS), National Center for Health Workforce Analysis, which projects a need for almost 30,000 orthopaedic surgeons in the United States by 2025 and an undersupply of approximately 5,000 orthopaedists or 17%. However, our experience is that most American orthopaedic surgeons would disagree with the HHS assessment. Consider, “Increased residency spots would need a corresponding increase in fellowship spots. And increase in number of jobs available. And increase in surgical procedures to support increased jobs. Not so simple.”
      Many decried the injustice, and with some degree of cynicism, some noted that orthopaedic applicants spend millions of dollars to participate in the match, (including more than $1 million invested by those 595 applicants who did not match in 2022).
      Further, in a debate quickly resolved, some asked if it could be that many of the unmatched were lesser candidates? The consensus answer was a resounding absolutely not! These “are strong candidates who don’t match. 40% not matching isn’t due to subpar candidates. Candidates are getting stronger every year.” By and large, these are “candidates who graduated at the top of their college class to be accepted to a medical school that accepts fewer than ten percent of its applicants and then completed medical school, pass(ed) their board exams … contribut(ed) to the library of medical science through research, then excelled in their rotations to get glowing letters of recommendations to apply to a specialty that has greater interest than available slots.”
      So how does this end? “The hard truth is that many of these unmatched doctors aspiring for ortho may need to seriously consider other specialties as a path to practice. There were several specialties that did not fill completely this year that could use their talent.” Similarly, “…a 60% match rate. The reality here is that every ortho applicant should … have a backup plan.”
      Finally, our reflections:
      First, as to the cause of the recent explosion of orthopaedic surgery residency applicants, we can only speculate. Orthopaedics is popular and competitive because we achieve outstanding outcomes; because many of our patients are relatively healthy and present with a specific problem that we are often able to cure or substantially improve; because orthopaedics is well remunerated; and because orthopaedic research, development, and technology continues to result in rapid and exciting innovation and commensurate improvements in the quality of care we are able to deliver. Yet, these factors have been in place for quite some time. Perhaps the 40% growth in the popularity of orthopaedic surgery among graduating medical students in the last few years is a result of our overdue and urgent emphasis on recruiting candidates to specifically achieve an increase in diversity, equity, and inclusion in our field.
      • Lubowitz J.H.
      • Brand J.C.
      • Rossi M.J.
      AANA21: Reflections on the combined AOSSM–AANA 2021 annual meeting.
      • Ryu R.K.N.
      The handshake or the fist.
      • Lubowitz J.H.
      • Brand J.C.
      • Rossi M.J.
      Physicians for social justice, diversity and equity: Take action and lead.
      • Cole B.J.
      Building our home: Lessons learned along the way.
      Women and under-represented minorities who were discouraged from applying to orthopaedics in the past are now being strongly encouraged, adding to the already robust applicant pool.
      Second, we sincerely feel horrible for those hundreds of deserving candidates who went unmatched. It seems to us that with a 40% rate of unmatched applicants, failing to match is largely a matter of bad luck. We genuinely hope that these worthy but unsuccessful candidates find success and fulfillment in their future careers, and trust that they will ultimately use their Doctor of Medicine and Doctor of Osteopathic Medicine degrees to make a strong and positive impact in orthopaedic surgery or elsewhere. As @SonyaSloanMD beautifully empathizes, “Sadly no way to calculate the lost hopes and dreams.”
      Third, we reiterate a tweet by @mdiesselmd, aka Matt M. Diesselhorst, M.D., “Bravo to those that matched!!” Congratulations and welcome to orthopaedic surgery, a field of medicine we find most fulfilling.
      Fourth, as seems clear based on what we have learned from this serious discourse on Twitter, the 40% unmatched applicant rate in the 2022 Orthopaedic Surgery Residency Match represents a titanic problem. “The system…is failing, not the students.” Yet, the conversation among the thoughtful Twitter participants suggests that there is no obvious consensus on a solution.
      Most of all, we reflect with immense, immense, immense gratitude, gratitude, gratitude how lucky, lucky, lucky we are to be orthopaedic surgeons. Back in the day, which for some of us was not so long ago, all that was required of us former medical students who desired to become orthopaedic surgery residents-in-training was study, study, study; work, work, work; strive, strive, strive; focus, focus, focus; commit, commit, commit; practice, practice, practice. Today, all of our efforts, tendered in triplicate, might not have been enough. Reflecting on the results of the 2022 Orthopaedic Surgery Residency Match, we feel incredibly fortunate and humbled to serve as orthopaedic surgeons with a subspecialty interest in Arthroscopy; Arthroscopy Techniques; and Arthroscopy, Sports Medicine, and Rehabilitation.

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