Gastroenterology fellowship application and match trends in the United States over a 12-year period, 2010 to 2022 (2024)

Abstract

Keywords: Fellowship, gastroenterology, match, trend

Gastroenterology (GI) has recently become one of the most competitive internal medicine (IM) subspecialties.1^,2 Increasing competition in the gastroenterology fellowship match (GFM) can pose difficulties to both applicants and programs, especially in the era of virtual interviews following the COVID‐19 pandemic. Numerous articles on how to become a stronger candidate and analyses of program directors’ views on the match have been published to help prospective gastroenterologists improve their chances of being matched in GI.1^,3^,4

Various characteristics and variables play a role in determining how competitive a specialty is, including but not limited to the number of positions offered, the number of applicants, and the number of overall programs.2 Recent match result information on GFM can provide valuable facts for applicants, mentors, and faculty. These data can help them predict match outcomes and improve the matching process. This topic is actively researched, debated, and discussed.2–4 This is the first comprehensive analysis of the GFM that spans a period of more than 10 years. In this study, we used publicly available data from the National Resident Matching Program (NRMP)5 to describe changes in IM subspecialty matching patterns over the past 12 years, focusing on GFM.

METHODS

We used publicly available data from the NRMP to screen applications and match data for all IM subspecialties from 2010 to 2022. Information on the annual number of positions offered and applications from 2010 to 2022 was collected from the NRMP archive.5 We used the specialty competitiveness ratio (SCR; number of applicants for the specialty/number of positions available in that specialty).6 While an SCR > 1 indicates more applicants than match positions, meaning that specialty is more competitive, an SCR < 1 indicates more match positions than applicants.

The annual growth rate was calculated for both fellowship positions and applications as the number of applications (or positions) of a specific year divided by the number of applications (or positions) of the previous year. The average annual growth rate was also calculated. One-sample t test was performed for the mean annual growth using an alpha of 0.05 and a null hypothesis of zero growth. In addition, we used compensation reports from the Medical Group Management Association (MGMA), AGMA, Medscape, Merritt Hawkins, Doximity, and the American Association of Medical Colleges to calculate the average annual salaries of IM specialists.7 We then calculated the correlation coefficient (R²) between annual salaries and the SCR.

RESULTS

Annual growth rates in applications and fellowship positions for each specialty since 2010 are shown in Figure 1. Gastroenterology has been the second-fastest growing specialty in match positions (4.61%) and applications (3.81%) since 2010 (Figure 1). Of note, cardiology, endocrinology, gastroenterology, hematology/oncology, pulmonary and critical care medicine (PCCM), and rheumatology all had statistically significant annual growth in fellowship positions. However, only GI and PCCM had statistically significant annual application growth (Figure 1). In 2022, the largest fellowships in terms of match positions were cardiology (1120), PCCM (1182), hematology/oncology (894), gastroenterology (616), and nephrology (484). The specialties with the most applicants were cardiology (1620 applicants), PCCM (1023), hematology/oncology (909), gastroenterology (974), and endocrinology, diabetes and metabolism (457). In 2022, GI had the fourth largest number of applications (974) and positions offered (616) (Figure 2).

Over the past 12 years, among IM subspecialties, GI was found to have the highest SCR of 1.58, followed by cardiovascular diseases (1.44) and hematology and oncology (1.42) (Figure 3). Infectious diseases, geriatrics, and nephrology were the only specialties with an SCR of < 1 (Figure 3).

We also found a correlation between yearly compensation and SCR. SCR positively correlated with monetary compensation across all specialties (R² = + 0.38) (Figure 4).

DISCUSSION

Based on our analysis, the GI fellowship is the most competitive IM subspecialty in the fellowship match, with a steady increase in applicants compared to available positions over the past 12 years. GI has gained increased attention and popularity among applicants in recent years compared to other IM subspecialties. This could be due to multiple reasons, including work-life balance, access to a procedural field, multidisciplinary and longitudinal care, and high compensation. In 2020, a Gastroenterologist Compensation Report published on the MGMA website showed that gastroenterologists had the second-highest salary in IM subspecialties.7 A Department of Health and Human Services report in 2006 estimated an overall shortage of specialty physicians in the US in 2025, including a projected shortage of 1630 gastroenterologists.8 In view of this expected shortage of gastroenterologists and the high level of competitiveness of the GFM, an increase in positions is critical.

The creation of more fellowship positions will be driven primarily by increasing the number of GI programs or expanding the size of existing programs. However, a survey of 181 GI fellows found that 61% plan to enter nonacademic practice, and only 39% said they would join an academic institution.9 This shortage of academic gastroenterologists could limit opportunities to expand GI fellowship programs. The factors behind the declining interest in academic careers are complex. One of the main factors that significantly limits academic participation is financial compensation, as evidenced by the fact that almost 60% of the surveyed fellows preferred academic institutions to private practice at similar salaries,9 which supports our finding of a positive correlation between SCR and monetary compensation. Another study showed that fellows driven by financial motives strongly prefer nonacademic practice. In contrast, fellows who choose academic practice are usually older, plan for further education, and desire fewer working hours per week.10

Additionally, the 2020 MGMA Compensation Report showed that gastroenterologists in academic practice earn $383,000 per year, while those in nonacademic practice earn approximately $539,908 per year.7 The large discrepancy in competitiveness between specialties such as cardiology and rheumatology can also be explained in financial terms. In cardiology, for example, those trained in invasive procedures are among the highest-compensated internists ($644,073), justifying the higher competitiveness, whereas the salary increment of rheumatologists is much lower.

CONCLUSION

With the increase in the ratio of GFM applicants to available GI spots over the past 12 years, competitiveness with GFM will continue to increase. Given the high level of competitiveness of the GI match and the expected deficit of gastroenterologists, an increase in positions seems optimal. In addition, with incentives currently favoring private over academic practice, faculty availability within fellowship programs may be limited. Additionally, no assumed funding source is currently in place that allows for an increase in GI positions within the existing programs or an increase in the number of GI programs. Unless practice patterns change, incentives increase, or program funding increases, there will likely be shortages of GI physicians, particularly academic GI physicians, in several crucial areas. Therefore, initiatives from labor markets, university endeavors, and federal efforts must take a dynamic perspective to accommodate changing career preferences throughout fellows’ training.

Conflict of Interest

The authors report no funding or conflicts of interest.

References