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The 2023 residency Match cycle broke a record for the most residency positions as well as the most applicants, the National Resident Matching Program (NRMP) said on Friday -- otherwise known as Match Day.

A total of 48,156 applicants participated in the 2023 Match, up by 481 from last year, according to the NRMP. "This rise in applicants was driven primarily by the increase of 707 more non-U.S.-citizen IMG [international medical graduate] applicants and 153 more U.S. osteopathic (DO) seniors over last year," while the number of U.S. MD senior applicants dropped by 236, the organization .

Of the total applicants, 42,952 certified a rank order list, an increase of 403 over last year. And among those with a certified list, 34,822 matched to a first-year position (PGY-1 position) at a rate of 81.1%, an increase of 1.0 percentage point over last year, the NRMP said.

For each of the four main applicant types, the matching rate was up from last year: U.S. MD seniors had a 93.7% match rate (up 0.8 percentage points from 2022), U.S. DO seniors were at 91.6% (up 0.3 percentage points), U.S. citizen IMGs matched at a 67.6% rate (up 6.2 percentage points), and non-U.S. citizen IMGs were at 59.4% (up 1.3 percentage points), according to the NRMP.

On the other side of the equation, residency programs offered the most certified positions ever, at 40,375, an increase of 1,170 positions over last year. Of those, 37,690 filled for a rate of 93.3%, down less than 1 percentage point from 2022.

Which specialties were the big winners? Those specialties with 30 positions or more that filled all available positions were orthopedic surgery, plastic surgery (integrated), radiology-diagnostic, and thoracic surgery. On the other hand, as 名媛直播 reported on Tuesday, there were 554 unfilled emergency medicine slots in 2023, an increase of 335 compared to last year. "The number of unfilled positions, driven in part by the decreased number of U.S. MD and U.S. DO seniors who submitted ranks for the specialty, could reflect changing applicant interests or projections about workforce opportunities post residency," the NRMP suggested.

The reasons for the jump in unfilled emergency medicine positions -- the exact spots and programs were -- are multifactorial, according to a from several emergency medicine groups published on the American College of Emergency Physicians (ACEP) website. Reasons include workforce projections, increased clinical demands, emergency department boarding, economic challenges, the COVID-19 pandemic, the corporatization of medicine, and others.

Primary care -- a topic of concern this year amid an increasing shortage of primary care doctors in the U.S. -- continued to do well overall. A total of 17,844 primary care residency slots were offered this year, up by 571 from last year. And primary care positions filled at a rate of 94.2%, similar to last year.

"The 2023 Main Residency Match proved once again to be a highly successful Match with outstanding results for participants," NRMP President and CEO Donna Lamb, DHSc, MBA, said in the press release. "We were excited to see the record number of primary care positions offered in this year's Match and how the number of positions has consistently increased over the past 5 years, and most importantly, the fill rate for primary care has remained steady."

The American Academy of Family Physicians that Friday's results "indicate that this will be the largest class of incoming family medicine residents in history, with 4,530 medical students and graduates matching into family medicine residency programs. This year, family medicine offered 5,107 residency positions, 172 more than in 2022, totaling 13.6% of positions offered in all specialties with more programs offering positions than any other specialty."

However, the picture isn't entirely rosy, Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who posts frequently about Match data, told 名媛直播. "Only 88.7% of family medicine positions filled," leaving 577 to be filled during the Supplemental Offer and Acceptance Program (SOAP) process offered to those who didn't match, he said in a text. "And only 29.1% of the available family medicine positions were filled by graduating U.S. MD students. (Graduating DO students filled another 29.7%.) That means that the number of U.S. MD and DO students who are interested in family medicine only fills a little more than half of the available family medicine training positions."

Other numbers from this year's Match Day included:

• 1,239 couples submitted choices for Match Day, up by 17 from last year, and 93% matched
• After family medicine and emergency medicine, the specialties with the largest numbers of unfilled slots were internal medicine (categorical) with 380, pediatrics (categorical) with 86, and psychiatry with 21
• The specialties filled with the largest numbers of non-U.S. IMGs included internal medicine (categorical) with 2,659; family medicine with 562; and pediatrics (categorical) with 401

In total, 2,685 positions were left unfilled in the match, up by 423 positions (18.7%) from last year, the NRMP said. Of those unfilled positions, 2,658 were placed in SOAP. Results from the SOAP process will be made available later this year.

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