Declining Rate of International Medical Graduates Matching Into Orthopedic Surgery Residency Programs in the United States: A 17-Year Analysis

Anisha Tyagi; Suleiman Y Sudah; Kathryn Whitelaw; Brett D Haislup; Tej Joshi; Pablo Sanchez-Urgelles; Joaquin Sanchez-Sotelo; Mariano E Menendez

doi:10.2106/JBJS.OA.24.00095

Declining Rate of International Medical Graduates Matching Into Orthopedic Surgery Residency Programs in the United States: A 17-Year Analysis

JB JS Open Access. 2024 Sep 20;9(3):e24.00095. doi: 10.2106/JBJS.OA.24.00095. eCollection 2024 Jul-Sep.

Authors

Anisha Tyagi¹, Suleiman Y Sudah², Kathryn Whitelaw³, Brett D Haislup⁴, Tej Joshi⁵, Pablo Sanchez-Urgelles⁶, Joaquin Sanchez-Sotelo⁷, Mariano E Menendez⁸

Affiliations

¹ Department of Orthopedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
² Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, New Jersey.
³ Department of Orthopedic Surgery, Icahn School of Medicine at Mt. Sinai, Manhattan, New York.
⁴ Department of Orthopedic Surgery, MedStar Health, Columbia, Maryland.
⁵ Department of Orthopedic Surgery, New Jersey Medical School, Newark, New Jersey.
⁶ Department of Orthopedic Surgery, Universidad Alfonso X El Sabio, Madrid, Spain.
⁷ Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
⁸ Department of Orthopedic Surgery, University of California Davis, Sacramento, California.

Abstract

Introduction: International medical graduates (IMGs) continue to play an important role in the US health care system, but little is known about their trends of matching into highly competitive residencies such as orthopedic surgery. The purpose of this study was to analyze temporal trends of IMG applicants matching into US orthopedic residency programs between 2008 and 2024 and compare them with US allopathic (MD) and osteopathic (DO) graduates.

Methods: Orthopedic residency specific data for years 2008 to 2024 was obtained from the National Resident Match Program and Electronic Residency Application Service. Variables collected included total number of programs, total positions offered, number of applicants (MD, DO, and IMG), positions filled, and fill rate for each group. Trends were examined using simple linear regression modeling.

Results: The number of orthopedic residency programs increased from 160 (2008) to 218 (2024), with total positions increasing from 636 (2008) to 916 (2024). The IMG fill rate decreased from 2.99% in 2008 to 0.87% in 2024 (p < 0.01 for linear trend; β -0.069). This corresponds to an absolute number decrease of 19 IMGs in 2008 to 8 in 2024. More specifically, the proportion of US IMGs decreased from 0.94% to 0.66%, and the proportion of non-US IMGs decreased from 2.04% to 0.21%. Over the 17-year study period, a total of 105 US IMGs and 110 non-US IMGs matched into orthopedic surgery. The US MD applicant fill rate decreased significantly from 96.5% to 85.0% (p < 0.001; β -0.944). The DO applicant fill rate increased significantly from 0.31% to 13.97% (p < 0.0001; β 0.990).

Conclusion: The declining rate of IMGs matching into orthopedic residency programs in the United States underscores the growing challenges faced by IMGs in accessing training in this competitive specialty. The notable increase in DO graduates securing orthopedic residency positions likely reflects the integration of a unified accreditation system for MD and DO residency programs established in 2020.

Level of evidence: Retrospective Cohort Study; IV.

Publication types

Review