# Session 23

Our episode with Dr. Chris Sahler was one of our most popular episodes. I decided to bring you the PM&R residency match data since many of you seem interested!

### [02:33] NRMP Main Match Data for 2017 – PGY-1 & PGY-2 Positions

Table 1 shows the match summary for all the different specialties and Physical Medicine & Rehabilitation only has 32 programs under PGY-1 positions. This is also one of those specialties where you can match into a PGY-2 spot and you have to separately apply for your internship. This table shows there are 62 programs for PGY-2 positions and that gives you a total of 94 programs. Just be careful when looking at data since some specialties may have they PGY-1 built-in while some do not.

Looking at PGY-1 spots, there are 119 positions. This is a relatively smaller program with almost 3 and 3/4 per program. And out of those spots, only one program went unfilled. There are 294 U.S. Seniors applying out of 595 in total who applied. (Remember for the purposes of this podcast when talking about match data, U.S. Seniors refer to U.S. allopathic students so these are students who are still in medical school going through the normal timeline so they're not taking any gap years after medical school.) This implies that more than half them applying for these spots are U.S. Seniors. Interestingly, only 74 U.S. Seniors matched for Physical Medicine & Rehabilitation out of 118 that matched.

Only 62.2% of the students that matched were U.S. Seniors. Comparing this to other specialties, 78.2% of those that matched in Emergency Medicine were U.S. Seniors, Neurosurgery at 83.9%, Neurology at 50.6%, and OB-GYNE at 81.4%. There is a very wide spectrum of what percentages of students matching are U.S. Seniors.

For PGY-2 Positions, students also need to rank and match into a PGY-1 spot, whether it's a surgery year, a transitional year, or an internal medicine year. So these are three different prelim years you can choose from. Out of those 62 programs, there were 294 spots available so it's almost 4 and 3/4 per program. This is a little bit bigger compared to PGY-1 position programs. And out of those 294 programs, none of them went unfilled. Out of 633 total applicants, 306 were U.S. Seniors and only 61.16% of those that matched were U.S. Seniors.

### [07:28] Matches by Specialty and Applicant Type

Table 2 of the 2017 NRMP Main Match Data shows us where the other people are coming from. For PGY-1 positions, 33 were osteopathic students out of 118 physicians that matched in PM&R. This is 27.97%

Compared to other specialties. Emergency Medicine had 283 matches for osteopathic students (a pretty big number for non-primary care) out of 2,041 total students. That's 13.9%. So PM&R is 14% higher than that which is very interesting.

Looking at this data, you can't say osteopaths are at a disadvantage because less osteopaths are matching into some of these surgical positions. But if a student goes to an osteopathic medical school because they believe in their philosophy and manipulation, then going into surgery maybe doesn't make sense and so is going into pathology. So you can't just look at the numbers. You have to look at what's the reasoning behind the numbers.

It's easy to hypothesize that osteopathic medicine fits very well with PM&R, which is basically, non-surgical orthopedics. You're dealing with people who have aches and pains and joint issues as well as other things and osteopathic medicine works with that. So these PM&R programs seem to be very open to osteopathic students. In fact, Dr. Sahler talked about this in Episode 13 that PM&Rs are very open to osteopathic physicians.

For PGY-2 spots, all 294 positions went filled. 181 were U.S. Allopathic Seniors, 5 were U.S. Grads (these are students outside of the normal timeline), and 83 were osteopathic students, which means 28.2% of osteopathic students actually matched. So if you're an osteopath and are interested in this stuff, you have a good shot to get a spot here. Moving on, 17 were U.S. International medical graduates, 8 were non-U.S. citizen international medical grads.

### [11:40] Positions Offered, U.S. Seniors, All Applicants, Osteopaths (2013-2017)

Table 3 tells us how the the number of spots is growing and looking at PM&R, it's growing slowly over the last four year at 0.4% every year for PGY-1 while for PGY-2, it's been growing much faster at 11% in 2017 from 10.9% in 2016. If you're interested in it, it's obviously a growing field for you.

Table 8 shows the percentages filled by U.S. Seniors versus all applicants from 2013-2017. It basically shows us a trend of what programs are doing, whether they prefer U.S. Seniors or U.S. Graduates or other students. Looking at PM&R for PGY-1, 62.2% in 2017 were U.S. Seniors, 61.16% in 2016, 60.7% in 2015, 56.3% in 2014, and 59.8% in 2013. So it has gone up pretty steadily over the last couple of years with more preference towards U.S. Seniors. For PGY-2, 61.6% U.S. Seniors matched, 52.8% in 2016, 45% in 2015, 53.7% in 2014, and 51.7% in 2013. There was a huge dip in 2015 which is really interesting.

Table 9 shows all applicants that matched by specialty. 0.4% of all students matched for PGY-1 spots matched into PM&R. Compared to other specialties, Surgery is 4.6%, Internal Medicine is 25.6%, Family Medicine is 11.6%, Anesthesiology is 4.1%.

Table 11 shows us osteopathic students matching into PGY-1 spots with 1.1% of all osteopathic medical students are matching into PM&R. Comparing that with the previous table of 0.4% by percentage, more osteopathics actually match into PM&R than allopathic students. This is very interesting yet it still goes with the fact that it does fit with osteopathic medicine.

### [15:12] Unmatched and SOAP

Figure 6 of the 2017 NRMP Main Match Data shows the Percentages of Unmatched U.S. Seniors and Independent Applicants Who Ranked Each Specialty as Their Only Choice. PM&R is near the top of the list for total unmatched students at 27.5%. Internal Medicine (Prelim) is the highest followed by Dermatology, Psychiatry, and then PM&R. Majority of these students are independent applicants which means they are not U.S. Allopathic Seniors. You have osteopathic students, U.S grads who are already out of school and international medical graduates making up this number. This is a little scary since PM&R is higher on the list. Remember there was only one unfilled position so it's highly sought after for a specialty.

Table 18 is all about the SOAP (Supplemental Offer and Acceptance Program). Again, there was only one unfilled spot in all of PM&R. So for the SOAP, there was also only one spot available and as expected, it was filled through the SOAP.

### [16:48] Charting the Outcomes 2016

Based on Charting the Outcomes 2016, Table PM-1 (Page 168 of 211) shows the number of contiguous ranks, Step scores, research, work experience, AOA, etc., to give you a picture of what these students look like for those who matched and did not match.

For U.S. allopathic Seniors, the mean number of contiguous ranks that matched are 14.2 programs while those that did not match were only 5.6. I can't stress enough the need for you to rank enough programs in order to match.

When you submit your rank list, you actually don't have to apply to only one specific residency program. You can apply to General Surgery and Orthopedic Surgery programs. For Physical Medicine & Rehabilitation, the mean number of distinct specialties ranked is 1.6 for those that matched and those that did not match were 2.2. Those ranking more programs are not going to be able to verbalize and communicate to these programs why they specifically want to go into PM&R because maybe they're out there ranking other programs.

Back on the data, the mean Step 1 score is 226, mean Step 2 score is 238. These are not terribly high Step scores. Those that did not match are 210 and 221 for Steps 1 and 2 respectively.

They have data for osteopathic students as well. Looking at Level 1 score for those that took the COMLEX, they have a 551 for those that matched and 492 for those that did not match, 563 for Level 2 that matched and 491 for Level 2 that did not match.

Charting the Outcomes 2016 Table PM-1 also looks at work experiences and volunteer experiences. AOA members comprised 6.2% of those that matched while 0% for those that were unmatched. (AOA in the allopathic world is for Allopathic medical students)

### [21:10] Medscape Physician Lifestyle and Compensation Reports

Normally, I would also check on the Medscape Physician Lifestyle and Compensation Reports but PM&R is not included in the data probably because it's a smaller field so they didn't have enough respondents for it. So we do not have enough feedback to have the data here.

## Links:

Specialty Stories Episode 13: What is Physiatry? (Physical Medicine & Rehabilitation)

Supplemental Offer and Acceptance Program (SOAP)

2016 Charting the Outcomes – NRMP

Medscape Lifestyle Report 2017

Medscape Physician Compensation Report 2017

## Transcript

### Introduction

Dr. Ryan Gray: Specialty Stories, session number 23.

Whether you’re a premed or a medical student, you've answered the calling to become a physician. Soon you'll have to start deciding what type of medicine you will want to practice. This podcast will tell you the stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your career.

Welcome to Specialty Stories. My name is Dr. Ryan Gray, host here for you every week on the Specialty Stories Podcast. This week I have another deep dive into residency data. Now if that's not your thing, that's okay, next week I should hopefully have a great interview for you with a forensic pathologist. That's assuming everything goes well and the appointment is kept and there's no conflicts coming up.

I do have an assistant helping me create a full list of specialties out there, all of the niches inside those specialties, all the sub-specialized niches in there, and we are starting to reach out to different physicians that meet those specialties. So hopefully we'll have some more interviews for you coming up soon.

Alright so today's deep dive is going to be into physical medicine and rehabilitation. Now I did a PM&R episode several weeks ago with my friend, Dr. Christopher Sahler, who is a PM&R doctor out in New York. And physical medicine, rehabilitation, also known as rehab medicine, PM&R; it's becoming more and more popular, and I got a lot of great feedback on that episode from students saying, ‘Wow that's a very interesting field.' And it is, so I wanted to break down the match data for you to show you how competitive it is, or non-competitive, and more. So let's go ahead and deep dive.

So if you want to follow along, go to the NRMP, the National Residency Matching Program, I think that's what it stands for. I just know it as the Match. If you just Google ‘Match data 2017,' it'll pull up. It's the full 124-page I think PDF document.

### NRMP Match Data – Physical Medicine and Rehabilitation

So table one on here has all of the match summary for all of the different specialties, and so when you look at physical medicine and rehabilitation it's very small. There are 32 programs. Now what's interesting when you look at table one under this PGY1 positions, that's what you see. So you have to be careful with some of these programs that there isn't another listing under PGY2. And so physical medicine and rehabilitation is one of those specialties where you can match into a PGY2 spot, and you have to separately apply for your internship year.

So be careful when you're looking at this data, and you go, ‘Oh there's only 32 programs.' There's actually 94 programs when you combine the PGY2 and the PGY1 spots. Some just have the PGY1 year built in, some do not. So be careful with that.

So let's go ahead and look at just the general overview here of PGY1 spots. Again 32 programs, 119 different spots. So relatively small program, almost three and three quarters per program. So smaller programs, and out of those 119 spots only one program went unfilled. There were 294 US seniors applying, and remember US seniors for our purposes for this podcast when we're talking about match data, US seniors are US allopathic students. So students that are still in medical school going through the normal timeline, not taking any years after medical school.

So out of- so there were 294 out of 525. So more than half of the students applying for these spots were US seniors. Now what's interesting here is that only 74 US seniors matched for physical medicine and rehabilitation, and out of the 118. So there were 118 students that actually matched for the 119 spots. So that one unfilled program was just spot. Only 62.2% of the students that matched were US seniors. And so let's give you a kind of comparison to see really where that ranks.

And so when we look at emergency medicine, which we talked about, 78.2% were US seniors. When you look at- let's look at neurosurgery here, 83.9% are US seniors. Neurology, very interesting, only 50.6%. And OBGYN, 81.4%. So there's a very wide spectrum of what percentage of students matching are US seniors. So for PGY1 positions for PM&R, only 62.2%.

So let's go ahead and jump down into the PGY2 positions. Again for these students, they need to also rank and match into a PGY1 spot whether that's a surgery year, a transitional year, or an internal medicine year. Three different prelim years that you can choose from.

So out of the 62 programs there were 294 spots available, and it's interesting, these programs are a little bit bigger so almost four and three quarters per instead of three and three quarters. So a little bit bigger going into the PGY2 position programs. And out of those 294 spots, none of them went unfilled.

There were 306 applicants out of 633, so a little bit less than half of those that applied, were US seniors. And what's interesting here again, pretty low number, only 61.6% of those that matched were US seniors. So again it was 62.2% for PGY1 spots, 61.6% for PGY2 spots. So very interesting. I wonder why it's a lower percentage of US seniors that are matching.

So when we look at table two, this is going to tell us where the other people are coming from. Table two is matches by specialty and applicant type. Applicant type meaning are they US seniors, US graduates meaning they're not in their normal timeline but still are allopathic MD graduates. Are they osteopathic students? Are they Canadian? Are they Fifth Pathway, which I haven't really talked much about here, or are they international medical grads?

So when we look at PM&R for PGY1, again there were the 119 positions, 118 were filled, only 74 were US seniors. Now here's kind of the interesting thing here. 33 were osteopathic students. So 33 out of the 118 positions were osteopathic students. So more than a quarter were osteopathic students.

Now I haven't done the actual math or data on all of the specialties, but I think that's a lot. So let me do some quick math here. So emergency medicine had 283 match which is a pretty big number here for non-primary care. So 283 out of 241. That's only almost 14%. So PM&R was an extra almost 11% or 12% higher than that, which is interesting. Very interesting. And it kind of makes sense, right?

### Osteopathic Students in Physical Medicine & Rehabilitation

So I've always talked about this, when you look at this data you can't go, ‘Oh osteopaths are at a disadvantage because less osteopaths are matching into some of these surgical positions,' or whatever they may be. If a student goes to an osteopathic medical school because he or she believes in their philosophy, and the touch of the physician, and manipulation, then going into surgery maybe doesn't make sense. Going into pathology definitely doesn't make sense. So when you think about it that way, you can't just look at the numbers, you have to look at kind of what's the reasoning behind the numbers. You obviously- I can't guess what the reasoning is, but I can hypothesize. And so when you look at this data it's easy to hypothesize.

Osteopathic medicine fits very, very well with PM&R. It's non-surgical orthopedics is what PM&R is basically to a layman, and osteopathic medicine fits that really well. You're dealing with people who have aches, and pains, and joint issues, and other things, and osteopathic medicine works for that. So you can see that these PM&R programs seem to be very open to osteopathic students. And if you remember Dr. Sahler talking about that in our episode, he said that PM&R is very open to osteopathic physicians. So it's very, very interesting.

Alright so those were the PGY1 spots. PGY2 spots, again 293 positions, all of them went filled. 181 went to US seniors, allopathic seniors, 5 went to US graduates, so they were outside of the normal timeline, but again 83 were osteopathic students. So again let's do a little math here. 83 divided by 294, and it's even higher, 28% osteopathic matched. So if you're an osteopath and you're interested in this stuff, you have a good shot to get a spot here.

Alright so and then when you look at the rest, a handful- 17 were US international medical graduates, 8 were non-US citizen international medical graduates.

Alright so moving down into table three, which tells us how the field is growing. When we look at PM&R, it's growing slowly over the last four years at 0.4% basically every years, the number of spots. So that's PGY1. And for PGY2, it has been growing much, much faster. So the growth for PGY2 was 11% in 2017, 10.9% in 2016, so the number of PGY2 positions that are opening up are much, much higher. So if you're interested in it, it's obviously a growing field for you.

Alright moving onto table eight which shows us the percentage filled by US seniors versus all applicants from 2013 to 2017. So this shows us a trend of what programs are doing, whether they prefer US seniors, or US graduates, or other students. And so when we look at this trend for physical medicine and rehabilitation, 62.2% in 2017 were US seniors, 61.6% in 2016, 60.7%, 56.3%, 59.8%. So it's gone up steadily over the last several years with more preference towards US seniors, but again we broke down that data earlier and there's still a lot of osteopathic students that are matching.

So those were the numbers for PGY1. If you look at PGY2, very similar numbers, 61.6% US seniors matching, 52.8%, 45%, 53.7%, 51%. So when you look at 2015 there was a huge dip down to 45% for matching into PM&R that were US seniors. So very interesting. I wonder what happened there.

PM&R is still pretty small when you look at table nine in All Applicants Matched by Specialty. PM&R is 0.4% of all students matched for PGY1. When you look at PGY2 spots- actually they don't have PGY2 spots, just PGY1. So when you look at PGY1 spots only, it's 0.4% of all students that matched, matched into PM&R. So when you look at some of the other programs to get an idea, surgery is 4.6%. And let me give you another one here. Internal medicine, huge obviously, almost 26%, family medicine almost 12%, anesthesiology 4.1%. So you can kind of see where that fits in.

And table eleven shows us osteopathic students matching into PGY1 spots. 1.1% of all osteopathic medical students are matching into PM&R. So when you compare that with the previous table of 0.4%, by percentage more osteopathic students match into PM&R than allopathic students, which is again very interesting but goes towards the fact that it kind of fits with osteopathic medicine.

And when we go down to figure six, very interesting data here. Percentages of unmatched US seniors and independent applicants who ranked each specialty as their only choice, physical medicine and rehabilitation is near the top of the list for total unmatched students at 27.5%. Internal medicine for prelim years, the highest. Dermatology, psychiatry, and then physical medicine and rehabilitation. The majority of these people though, the majority of these students are independent applicants meaning they're not US seniors, they're not students still in school at an allopathic medical school. So you have osteopathic students, you have US graduates who are out of school already, you have international medical graduates making up this number.

So it's a pretty big number, it's higher up on the list for unmatched, so that kind of is a little scary, and remember looking back at the data there was only one unfilled position. So it's highly sought after for a specialty.

Alright so moving down to table eighteen, it's all about the SOAP. And if you remember going back up, there was only one unfilled spot in all of PM&R. So for the SOAP, which is the Supplemental Offer and Acceptance Program, there was only spot available, and as expected it was filled through the SOAP.

### Charting the Outcomes

Alright and moving onto Charting the Outcomes- so all the data that I was just talking about, again from the NRMP, go to their website, look for match data for 2017. Charting the Outcomes is still from 2016 so it will be a little bit different as far as what year I'm reporting on but should still help with your thought process on kind of the specialties, and how competitive it is for you.

So in the Charting the Outcomes in table PM-1, PM meaning physical medicine, it gives us the number of contiguous ranks, Step scores, research, work experience, AOA, stuff like that to give you an idea, a picture of what these students look like; those that matched and those that did not match.

So when you look at the allopathic seniors- so MD seniors in Charting the Outcomes 2016 for PM&R. Those that matched ranked 14.2 programs as a mean number of contiguous ranks. Those that did not match were only 5.6. So I've stressed this as many times as I can when I break down this data, you need to rank enough programs to match.

Alright and the second one here is interesting, the mean number of distinct specialties ranked. So when you- maybe you don't know this. When you submit your match list, your rank list, you don't have to only apply to one specific residency program. You can apply to general surgery and orthopedic surgery programs. It's a little different, and I don't know- I don't have data on how average it is for students to do that, or I haven't looked at that data, but for students here for physical medicine and rehabilitation, those that matched were 1.6, the mean number of distinct specialties ranked. And those that did not match were 2.2. And to me that just makes sense. Those that are ranking more programs aren't going to be able to verbalize and communicate to these programs specifically why they want to go into PM&R, because maybe they don't because they're out there ranking other programs. So it's an interesting thing.

Mean Step 1 score, 226. Step 2 score, 238. So not terribly high Step scores. Those that did not match, 210 and 221, significantly lower. One thing that I just found that I hadn't looked at before, they have Charting the Outcomes for osteopathic students as well. And so when we look at osteopathic students, they have the Level scores in here for osteopathic students that matched into physical medicine and rehabilitation.

So when you look at Level 1 score for those that did well on COMLEX, or took the COMLEX, they had a 551 for those that matched, 492 for those that did not match, 563 for Level 2, 491 for Level 2 that did not match. So very interesting, a lower Level 2 score for those that did not match. And again you can go look at this data, Charting the Outcomes, table PM-1 for physical medicine and rehabilitation. It looks at work experiences and volunteer experiences, AOA I'll talk about. AOA has 6.2% were AOA members versus 0% for those that were unmatched in the allopathic world. AOA is for allopathic medical students. So it gives you something to think about as you are looking at physical medicine and rehabilitation, if you are looking at it.

Normally I dig into physician lifestyle and compensation reports from MedScape as well. The lifestyle report does not have PM&R on it, probably because it's a small field, they did not have enough respondents for it, I am assuming. Looking at the compensation report, it's not on here either. So again, not enough feedback to have the data on here. So unfortunately you'll have to dig into those- that data separately.

### Final Thoughts

So hopefully this was helpful for you. Again I have some interviews coming up, give you more information. The biggest struggle for me, as I've mentioned here, is finding people to interview. Interviewing physicians is a struggle sometimes, they're working full time, and I'm doing other things other than podcasting believe it or not with my four podcasts, but I will have some interviews coming up for you shortly.

So I hope you enjoyed this episode, and I hope you have a great week. We'll see you next time here at Specialty Stories.

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