Preliminary Analysis—ASN Data Brief

I. Executive Summary

The appointment year (AY) 2020 nephrology Match results were exactly flat compared with last year according to preliminary data from the National Resident Matching Program (NRMP). A total of 291 candidates matched into one of 169 participating tracks, filling 62% of 469 offered positions. Only 41.4% of tracks and 62% of positions filled.

Among the key data points:

  • Matched International Medical Graduates (IMGs) were â–²4% year over year (YOY), extending a three-year increasing trend.
  • Just 69 US allopathic fellows matched in nephrology (â–¼14% over AY 2019) after Electronic Residency Application Service (ERAS) data indicated US MD candidates were â–¼13%. Of note, US medical graduates (USMGs) entering internal medicine (IM) were â–¼22% over the past 10 years, comprising just 41.5% of IM residents in 2019.
  • Training tracks and positions offered edged up over AY 2019 (â–²4% and â–²2%, respectively) at the same time candidates were â–²2.39% YOY.
  • Matched osteopathic candidates were â–²18% YOY, although they still comprise a small proportion (15.5%) of matched fellows.

II. AY 2020 Match

Advanced NRMP data reported 174 participating tracks (â–²5% over AY 2019) and 473 slots (â–²2%) for the AY 2020 nephrology Match. However, only 169 tracks were reported in the preliminary Match results (see Table 1) â–²4% over AY 2019.

Table 1: Nephrology Match Results

Source: National Resident Matching Program, 2009–2019. Available at http://www.nrmp.org/fellowship-match-data/.

Unfilled training tracks…

…and unfilled positions edged up in the AY 2020 Match.

While the gap in offered and filled positions remained flat…

…for training tracks it increased slightly.

The growth of osteopathic nephrology fellows has continued…

…and proportions of candidates preferring nephrology obtaining a position dipped.

III. ERAS Application Data

Although data captured until the end of November show IMG candidates edged up this year (▲5% over AY 2019), because of a new ERAS policy it’s not possible to know how many are US IMGs (who comprised 20% of matched fellows in AY 2019 and whose numbers have been increasing) versus foreign IMGs (whose numbers have declined 33% since AY 2009). Osteopathic fellows have more than doubled since nephrology rejoined the Match in AY 2009, yet still comprise a small number of fellows overall (13% in AY 2019). According to data from ERAS, the total number of US MDs are ▼ 13% YOY.

Candidates and applicants continued the slight YOY growth trend (â–²2.39% and â–²1%, respectively). The decline in YOY growth in applications could be an indicator of declining seletivity, with candidates applying to fewer programs than in previous application cycles.

IV. NRMP Data

Nephrology is one of 17 subspecialties participating in the Medical Specialties Matching Program (MSMP), and one of three that have implemented an All-In Policy. Since rejoining the Match for AY 2009, the number of unfilled subspecialty positions â–²291% between AY 2009 and AY 2019 (from 145 to 567 slots).

This year 22% of IM subspecialty candidates did not acquire a fellowship training position through the MSMP (flat compared to AY 2019), including 291 US MDs, 202 DOs, and 363 US IMGs.

Over this same time period the internal medicine (IM) pipeline has steadily grown, yet the proportion of US medical graduates (USMGs) entering IM has declined 22% over the past 10 years, comprising just 41.5% of residents in 2019. While most incoming medical subspecialty fellowship classes have mirrored this proportion, nephrology has attracted fewer US graduates, dropping below 25% of candidates matched in AY 2011.

Percent USMGs Matched in Pipeline Specialties

Percent USMGs Matched in Medical Subspecialties

V. Nephrology Training Landscape

Despite several closures the total number of accredited nephrology training programs overall (not training tracks) has remained steady at 149. This is partially due to the incorporation of five osteopathic fellowships through Single Accreditation, with an additional new allopathic program in Colorado. New data from the ASN Nephrology GME Census found an uptick in 1st-year fellows (partially due to inclusion of off-cycle trainees), while 32% of current nephrology trainees entered fellowship through the post-Match scramble process, which lacks the structure of the ERAS application cycle and NRMP Match.

The ratio of matched fellows to fellowship positions in the Match has been <1 since AY 2016, although increasing slightly over the past two years. Most recent cross-registration data from ERAS shows that 60% nephrology candidates applied to at least one other specialty (note dark grey squares in the heat map indicate no observations).

Ratio of Matched Fellows to Available Positions

Cross-Registrations for Medical Subspecialities