INTRODUCTION

Geography is consistently cited as an important factor in residency applicant decision-making,1 but little is known about where students match into residency based on medical school of origin. We aimed to characterize geographic trends for US graduating allopathic seniors participating in the National Resident Matching Program (NRMP).

METHODS

De-identified NRMP data were obtained for all US graduating allopathic seniors participating in the 2011–2015 Main Residency Match® in all specialties. Data were grouped into four geographic regions and nine divisions based upon applicants’ medical schools using US census definitions (Fig. 1). “Home” region/division was defined as applicants matching into the same geographic region and division where their medical school was located. Chi-square and logistic regression analyses were performed using Stata, controlling for year and using East North Central (ENC) division as the referent group. This study was exempted by the University of Chicago IRB (IRB126–0721).

Figure 1
figure 1

Percentage of applicants who matched in their home geographic region and division (i.e., the same geographic region and division where their medical school was located).

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RESULTS

Of 84,810 US seniors participating in the Match, 80,707 matched (Table 1). Sixty-three percent of applicants matched at programs within their home regions (n = 50,809), and 51% within home divisions (n = 40,973), with variation between regions and divisions (Fig. 1). These proportions did not differ significantly from 2011 to 2015 (region χ2 = 5.6, p = 0.23; division χ2 = 7.9, p = 0.09). The odds of an applicant matching within their home division were highest in the Pacific division (OR = 1.79, 95%CI [1.69–1.90], p < 0.001), and lowest in the Mountain (OR = 0.64, 95%CI [0.58–0.69], p < 0.001) division, compared to ENC. Programs had highest odds of matching residents remaining in home divisions in the West South Central division (OR = 1.30, 95%CI [1.23–1.38], p < 0.001), and lowest in the Mountain division (OR = 0.22, 95%CI [0.21–0.24], p < 0.001), compared to ENC.

Table 1 Geographic Distribution of Matched Allopathic Applicants and Residents in All Specialties 2011–2015
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DISCUSSION

This study uses national data to describe geographic trends in the residency Match. Our results objectively demonstrate that residency applicants, on average, have matched in relatively close geographic proximity to their medical schools in recent years, though there is significant variability between regions and divisions. From the program perspective, there is much more inter-divisional variation in the proportion of matched residents recruited from that division. Low percentages of matched residents from the program division, such as seen in Mountain (26%) and New England (32%) divisions, may indicate desirability of the divisions to outside applicants, or may reflect the greater number of matched residents than graduating students in those divisions, making broader recruitment necessary. Perhaps surprisingly, we found that the proportion of students remaining in their home division has not changed significantly over the 5 years we examined, despite anecdotal perceptions of increasing regionalization in the recruitment process.

Our results confirm a longstanding view that students tend to match locally and strengthen prior work in this area. Previous studies have been narrowly focused, primarily in surgical subspecialties which may not be generalizable, and suffer from incomplete data that is potentially subject to bias.2,3,4 To our knowledge, this is the first study to use objective, nation-wide data to examine this question.

Additionally, this work has potential to inform the growing body of literature about application inflation in the residency Match, a rising issue in medical education5. While our data provides a broad view of geographic trends, further study may help applicants better understand the geographic matching patterns of programs of interest within certain areas, thus allowing applicants to more carefully consider their application strategy. Likewise, residency programs trying to conserve resources may use these data and future work to understand potential geographic factors when making decisions to offer limited number of interviews. However, while this has the potential to improve recruitment efficiency and reduce costs, it may disadvantage students wishing to move to a new geographic area.

While the data supporting our findings are robust, our study has important limitations. Data available from the NRMP were stripped of potential identifiers beyond year and geography, and therefore groups encompassed an amalgam of heterogeneous institutions. We also lack data on applicants’ other geographic ties, such as locations of family or spouses, which are likely to have an outsized effect on application decisions. Further, applicant competitiveness, as gauged by USMLE scores, grades, and honor society membership, were not available. Regardless, this study is the first to describe geographic trends in the Match using nationally available data from the NRMP and provides foundational evidence in this area.