National Resident Matching Program. NRMP policy change: all positions in the match. Available at: http://www.nrmp.org/allinnewrulesept11.pdf. Accessed November 20, 2012.
Liaison Committee on Medical Education (LCME). Developing medical education programs. Available at: http://www.lcme.org/newschoolprocess.htm. Accessed November 20, 2012.
- •Median total cost of recruitment per program was $148,000.
- •Largest determinate of cost was program size.
- •Programs considering expanding can anticipate spending at least $6000 per additional postgraduate year 1 (PGY1) position.
- •About 25% of PGY1 positions were filled outside the match.
- •If all 362 Internal Medicine programs went “all-in,” this would add an estimated $8.9 million to recruitment cost nationwide.
National Resident Matching Program. NRMP policy change: all positions in the match. Available at: http://www.nrmp.org/allinnewrulesept11.pdf. Accessed November 20, 2012.
Methods
Survey of Program Directors
American Board of Internal Medicine. Resident and fellow workforce data. Available at: http://www.abim.org/about/examInfo/data-workforce.aspx. Accessed November 20, 2012.
Estimation of Recruitment Costs
AMGA Medical Group Compensation and Financial Survey 2008. Salary by specialty and region. Available at: http://www.morganmdsearch.com/resources/AMGACompensationFinancial%20Survey2008.pdf. Accessed November 20, 2012.
U.S. Census Bureau. Census regions and division of the United States. Available at: http://www.census.gov/geo/www/us_regdiv.pdf. Accessed November 20, 2012.
American Medical Association. Graduate medical education: Fellowship and Residency Electronic Interactive Database Access system online (FRIEDA). Available at: https://freida.ama-assn.org/Freida/user/viewProgramSearch.do. Accessed November 20, 2012.
Clayton CP. AIM-APM 2008 survey. Salary survey highlights from 2008. Available at: http://www.im.org/Publications/Insight/Archives/Documents/Vol6Issue2/AIMAPMSurvey.pdf. Accessed November 20, 2012.
Associate Program Directors in Internal Medicine (APDIM) Program Administrators 2009 Survey. Regional survey reports. Available at: http://www.im.org/toolbox/surveys/APDIMSurveyData/Pages/default.aspx. Accessed November 20, 2012.
Bureau of Labor Statistics. 2010 annual mean medical secretary salary data by state. Available at: http://www.bls.gov/oes/2010/may/oes436013.htm. Accessed November 20, 2012.
American Medical Association. Graduate medical education: Fellowship and Residency Electronic Interactive Database Access system online (FRIEDA). Available at: https://freida.ama-assn.org/Freida/user/viewProgramSearch.do. Accessed November 20, 2012.
American Board of Internal Medicine. Residency program pass rates 2006-2009. Available at: http://www.abim.org/pdf/pass-rates/residency-program-pass-rates.pdf. Accessed December 1, 2009.
Accreditation Council for Graduate Medical Education. Accredited programs – internal medicine. Available at: http://www.acgme.org/adspublic/. Accessed December 1, 2009.
National Residency Match Program (NRMP). Program results 2009 main residency match. Available at: http://www.nrmp.org/data/resultsanddata2009.pdf. Accessed November 20, 2012.
Statistical Analyses
Results
U.S. Census Bureau. Census regions and division of the United States. Available at: http://www.census.gov/geo/www/us_regdiv.pdf. Accessed November 20, 2012.
American Medical Association. Graduate medical education: Fellowship and Residency Electronic Interactive Database Access system online (FRIEDA). Available at: https://freida.ama-assn.org/Freida/user/viewProgramSearch.do. Accessed November 20, 2012.
American Board of Internal Medicine. Residency program pass rates 2006-2009. Available at: http://www.abim.org/pdf/pass-rates/residency-program-pass-rates.pdf. Accessed December 1, 2009.
Accreditation Council for Graduate Medical Education. Accredited programs – internal medicine. Available at: http://www.acgme.org/adspublic/. Accessed December 1, 2009.
Characteristic | n (%) |
---|---|
Census region | |
Northeast | 104 (38.5%) |
South | 68 (25.2%) |
Midwest | 63 (23.3%) |
West | 35 (13.0%) |
Program description | |
Community-based, university-affiliated | 142 (52.6%) |
University-based | 91 (33.7%) |
Community-based | 37 (13.7%) |
Accreditation cycle length, y | |
<3 | 26 (9.6%) |
≥3-<5 | 72 (26.7%) |
≥5 | 172 (63.7%) |
Government affiliation | |
Yes | 62 (23.0%) |
No | 208 (77.0%) |
Presence of unfilled positions | |
>3 | 92 (34.1%) |
≤3 | 178 (65.9%) |
Recruitment Characteristics and Interview Day
All Programs (n = 270) | University Based (n = 91) | Community Based University Affiliated (n = 142) | Community Based (n = 37) | P Value | |
---|---|---|---|---|---|
Recruitment, mean (SD) | |||||
Total applications received | 2314 (1579) | 2270 (1107) | 2473 (1865) | 1804 (1191) | |
Total USMG applications | 362 (467) | 715 (609) | 195 (242) | 177 (199) | |
Total interviews extended | 225 (142) | 306 (137) | 193 (134) | 156 (97) | |
Total interviews conducted | 173 (112) | 242 (113) | 143 (99) | 123 (76) | |
Applications received per PGY1 position | 159 (208) | 94 (58) | 197 (267) | 162 (118) | .002 |
USMG applications per PGY1 position | 18 (19) | 24 (18) | 14 (19) | 16 (16) | .0006 |
Interviews extended per PGY1 position | 13 (6) | 12 (4) | 14 (7) | 13 (6) | .02 |
Interviews conducted per PGY1 position | 10 (4) | 9 (3) | 10 (5) | 10 (5) | .07 |
Interviews conducted by program director | 57 (72) | 55 (76) | 61 (73) | 45 (56) | .45 |
Interview day components, n (%) | |||||
Tour | 264 (98%) | 90 (99%) | 137 (97%) | 37 (100%) | .98 |
Lunch | 249 (92%) | 89 (98%) | 125 (88%) | 35 (95%) | .56 |
Program director overview/slideshow | 228 (84%) | 85 (93%) | 115 (81%) | 28 (76%) | .04 |
Breakfast | 189 (70%) | 78 (86%) | 89 (63%) | 22 (60%) | .04 |
Morning report | 187 (69%) | 72 (79%) | 92 (65%) | 23 (62%) | .02 |
Greeting by Chair of Medicine | 142 (53%) | 76 (84%) | 58 (41%) | 8 (22%) | .0005 |
Noon conference | 137 (51%) | 29 (32%) | 81 (57%) | 27 (73%) | <.0001 |
Dinner the night before interview | 112 (42%) | 66 (73%) | 39 (28%) | 7 (19%) | <.0001 |
Attending rounds | 53 (20%) | 17 (19%) | 30 (21%) | 6 (16%) | <.0001 |
Patient care rounds with residents | 25 (9%) | 11 (12%) | 11 (8%) | 3 (8%) | .77 |
Faculty panel interview | 24 (9%) | 7 (8%) | 10 (7%) | 7 (19%) | 0.52 |
Applicants interviewed as a group | 7 (3%) | 1 (1%) | 4 (3%) | 2 (5%) | 0.16 |
Other | 30 (11%) | 11 (12%) | 18 (13%) | 1 (3%) | 0.10 |
Estimates of Recruitment Costs
Cost Component | All Programs (n = 270) | University Based (n = 91) | Community Based University Affiliated (n = 142) | Community Based (n = 37) |
---|---|---|---|---|
Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | |
Program director effort | $42,400 ($27,750-59,375) | $50,000 ($37,500-72,521) | $37,500 ($25,000-56,250) | $37,500 ($25,000-50,000) |
Associate program director effort | $52,022 ($23,376-89,291) | $86,703 ($57,820-140,253) | $38,781 ($19,273-60,692) | $28,910 ($18,700-63,602) |
Chief resident effort | $12,206 ($4346-25,450) | $25,425 ($12,226-42,383) | $8198 ($1380-15,282) | $5794 ($0-16,953) |
Administrative staff effort | $29,650 ($19,582-41,919) | $40,420 ($27,562-56,113) | $26,257 ($17,505-35,134) | $19,693 ($14,190-31,004) |
Department of medicine chair effort | $369 ($0-854) | $699 ($427-932) | $0 ($0-777) | $0 ($0-0) |
Food | $4850 ($2400-10,000) | $10,000 ($4850-24,000) | $4225 ($2000-5000) | $2000 ($900-4850) |
Supplies | $600 ($300-1000) | $1000 ($600-2000) | $600 ($250-1000) | $500 ($200-600) |
Hotel | $0 ($0-700) | $0 ($0-4500) | $0 ($0-1000) | $0 ($0-0) |
Total estimated recruitment cost per program | $148,345 ($95,966-234,704) | $239,821 ($162,815-317,526) | $120,920 ($87,933-187,916) | $105,256 ($81,880-140,980) |
Cost per PGY1 matriculate | $9899 ($6494-13,271) | $9639 ($6438-12,898) | $9809 ($6347-13,337) | $10,347 ($7382-13,293) |
Cost per NRMP matched position) | $14,162 ($9741-22,605) | $11,058 ($7792-14,708) | $16,387 ($11,162-24,334) | $20,939 ($13,647-28,096) |
- •University affiliation (β = +$119,244; P <.0001),
- •Government affiliation (β = +$91,467; P <.0001),
- •Location in the West (β = +$75,832; P = .01),
- •Having >3 unfilled positions (β = +$74,027; P = .0003),
- •A higher percentage of volunteer faculty (β = −$1069; P <.0001), and
- •Larger PGY1 class size (β = +$6787; P <.0001).
n (%) | Median (IQR) | Unadjusted | Adjusted | |||
---|---|---|---|---|---|---|
β (SE) | P Value | β (SE) | P Value | |||
Census region | ||||||
West | 35 (13.0%) | $215,881 ($122,032-317,526) | +$75,832 (30,694) | .01 | +$22,282 (21,476) | .14 |
South | 68 (25.2%) | $144,031 ($95,424-222,730) | +$7032 (20,816) | .76 | −$15,139 (14,260) | .45 |
Midwest | 63 (23.2%) | $160,243 ($96,514-247,841) | +$20,193 (27,885) | .43 | +$3459 (12,226) | .83 |
Northeast | 104 (38.5%) | $139,831 ($91,892-218,772) | $140,050 (11,710) | - | ||
Program description | ||||||
Community-based | 37 (13.7%) | $105,256 ($81,880-140,980) | −$15,321 (12,086) | .08 | +$14,717 (10,251) | .13 |
University-based | 91 (33.7%) | $239,821 ($162,815-317,526) | +$119,244 (17,677) | <.0001 | +$31,899 (20,540) | .05 |
Community-based, university affiliated | 142 (52.6%) | $120,920 ($87,933-187,916) | $120,577 (8522) | - | ||
Accreditation cycle length, y | ||||||
<3 | 26 (9.6%) | $126,666 ($79,272-239,054) | −$33,482 (33,340) | .21 | −$3081 (24,184) | .63 |
≥3-<5 | 72 (26.7%) | $117,690 ($88,053-214,281) | −$50,981 (16,299) | .03 | −$20,724 (9891) | .08 |
≥5 | 172 (63.7%) | $169,669 ($104,694-242,558) | $169,441 (10,790) | - | ||
Government affiliation | ||||||
Yes | 62 (23.0%) | $227,776 ($140,294-317,526) | +$91,467 (19,655) | <.0001 | +$32,328 (27,317) | .49 |
No | 208 (77.0%) | $133,193 ($91,892-212,075) | $135,960 (8749) | - | ||
Presence of unfilled positions | ||||||
>3 | 92 (34.1%) | $201,555 ($115,724-269,792) | +$74,027 (17,228) | .0003 | +$5035 (13,543) | .99 |
≤3 | 178 (65.9%) | $126,216 ($88,583-216,368) | $126,890 (9400) | - | ||
Mean (SD) | Expected Median (SE) | |||||
ABIM rolling pass rate 2006-2008, % | 92.6 (6.1) | $149,957 (8446) | +$1952 (1401) | .16 | +$420 (744) | .50 |
Volunteer faculty, % | 40.7 (35.4) | $163,162 (8092) | −$1069 (208) | <.0001 | −$190 (158) | .35 |
Positions filled outside NRMP Match, n | 4.5 (5.5) | $149,808 (9950) | −$2786 (1136) | .04 | −$5446 (1069) | .0001 |
PGY1 categorical positions, n | 18.6 (11.1) | $165,978 (5076) | +$6787 (652) | <.0001 | +$6073 (981) | <.0001 |
Discussion
National Resident Matching Program. NRMP policy change: all positions in the match. Available at: http://www.nrmp.org/allinnewrulesept11.pdf. Accessed November 20, 2012.
Liaison Committee on Medical Education (LCME). Developing medical education programs. Available at: http://www.lcme.org/newschoolprocess.htm. Accessed November 20, 2012.
National Resident Matching Program. NRMP policy change: all positions in the match. Available at: http://www.nrmp.org/allinnewrulesept11.pdf. Accessed November 20, 2012.
Acknowledgment
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Article Info
Publication History
Footnotes
Funding: This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the ACGME Educational Innovations Project.
Conflicts of Interest: None.
Authorship: All authors have met criteria for authorship and have approved the final manuscript.