Three years ago, we published an article entitled “Is there a Crisis in the Otolaryngology Match?” In 2017, the number of U.S. applicants fell below the number of residency spots available; 14 spots went unfilled that year. It was the culmination of years of Matches, as otolaryngology had earned a reputation as one of the most difficult residencies to match. Faculty were often seen as unwelcoming to junior medical students, and in the years leading up to 2017, residency programs instituted a program-specific paragraph component to the application and trialed a personality fit test. Many students felt that these were both unnecessary and onerous.
Many meetings were held, articles were published, and academic residency groups refocused their efforts on recruitment. Nearly every program revived their student interest groups, and residency programs quickly began seeing a 30% increase in applications. Interview days became showcases for programs, with lavish three-course meals replacing box lunches—some programs even paid for hotel accommodations prior to interviews. Now, four years later, the pendulum has swung back in otolaryngology programs’ favor. But at what price?
Match Day was March 19, 2021, and it was a banner day for the specialty. As compared to the 14 unfilled positions in 2017, there were 0 unfilled this year. There were roughly 250 more applicants than positions, and the quality of these was as good as, if not better than, applicants in any year I can remember. Multiple publications, top-of-the-class grades and USMLE scores, meaningful community service projects, and universally glowing letters of recommendation made selection amongst this talented group a bit of a crapshoot. A virtual format that made it easier for applicants and programs to do more interviews without the expense of traveling further underscores how this year was very different from years past. On March 19, I, like nearly every other academic chair and program director in the country, was extremely pleased with the results and eager to meet our new otolaryngology residents.
But there’s a flip side to this story, one our specialty needs to address. There were more than 200 students who did not match, many of whom didn’t have a back-up plan. For the unmatched, there’s a process called the Supplemental Offer and Acceptance Program (SOAP) in which they can scramble for jobs over a three-day period of time. Students who had worked for the past three and a half years to become otolaryngologists scrambled to find preliminary surgery, internal medicine, and anesthesiology positions. Students with USMLE scores >250 and AOA who had 20 or so interviews and were dreaming of being an otolaryngology resident at a top academic center found themselves competing for spots in community surgery programs and nonsurgical fields. Some elected to pursue a research fellowship or extended their medical school training by another year to increase their chances of matching next time. Taking on the added expense of another year of med school can help them avoid being branded as a “graduated reapplicant,” as these applications were often triaged out in a program’s interview selection process.
So, what needs to be done? Here are my suggestions:
- For starters, our engagement with prospective medical students needs to continue. We want to attract the best and brightest medical students, and we have a long way to go to better our recruitment of students of color, as our specialty remains one of the least diverse fields by race.
- We need to eliminate the mistakes of years past in pushing personality tests and other application barriers.
- As mentors to these students, we need to counsel them on the importance of having a competitive application, including their research publications, and dual applying to another field as a back-up plan.
- As a specialty, we should look at participating in the early Match again. It gives unmatched students more time to apply for other competitive specialties and avoid the uncertainty of the SOAP process.
Otolaryngology is a wonderful specialty, and I congratulate our new trainees, but I also feel for those whose dreams have hit a bump in the road. It’s my hope that we work together to improve the residency selection process for all.