Residency Specialty Choice Trends Over 24 Years

Studies have shown a decrease in the match rate in general medical and primary care-focused specialties among US medical school graduates and an increase in that of subspecialties with “controllable lifestyles.” We evaluated the percentage of Harvard Medical School graduates who matched into high-income controllable lifestyle, low-income controllable lifestyle, and noncontrollable lifestyle specialties from 1994 to 2017. Using linear regression, we found that the percentage of students matching into high-income and low-income controllable lifestyle specialties has increased over time, while those matching into noncontrollable lifestyle specialties – comprised largely of primary care fields – decreased. Such trends may impact the US physician workforce composition over time, with growth of residency positions into fields such as internal medicine exceeding the matriculation of U.S. medical graduates into these positions. We examine whether future policies should focus on incentivizing students to pursue such noncontrollable lifestyle specialties by highlighting controllable lifestyle elements within these fields and emphasizing alternative rewards which may attract candidates to these pursuits.