Trends for 2024 Match Reveal More Applicants Interested in Surgery

The National Resident Matching Program’s (NRMP) annual Match, the day wherein medical trainees learn whether they have matched into a main residency practice location, is a time of excitement for hopeful physicians, including surgeons. Tens of thousands of individuals apply to their desired hospital, health systems, and specialties, and the majority are successfully placed.

March 15 was the 2024 Match Day in the US, and an all-time high number of applicants showed that interest in medicine as a career continues to grow. The field of surgery also remains desirable, as general surgery and other disciplines had exceptionally high match rates.

Overall, match rates for all applicant types remain steady compared to previous years. However, observations and suggestions can be gleaned for medicine, including surgery, by examining the numbers and trends, particularly in the context of a workforce in need of reinforcement.

Overall Numbers

By any metric, this 2024 Match was a successful one. A total of 50,413 applicants registered across all physician domains, including general surgery and other surgical disciplines, which is an increase of nearly 5% from 2023. 44,853 of these applicants certified a rank order list, another record high that increased more than 4% from last year.¹

Within these records numbers, the four main applicant types, including US MD seniors (the largest applicant group), US DO seniors, US citizen international medical graduates (IMG), and non-US citizen IMGs applied for 41,503 positions across 6,395 residency training programs—also all-time high figures.¹

Most significantly, 38,941 positions were filled, representing a match rate of 93.8%—a 0.5 percentage point increase from 2023.¹ An additional 2,575 positions were offered in the Supplemental Offer and Acceptance Program (SOAP) to applicants who did not match in the algorithm phase of the Match, in which 2,399 additional positions were filled.²

It is clear that the desire for a career as a physician has never been higher.

“We’ve got a consistently growing field of applicants who are seeking residency training,” said Donna L. Lamb, DHSc, MBA, president and CEO of the NRMP. “This year, there were many applicants, and many positions with more than 100 additional programs, and they are consistently being filled. This is an effective mechanism in which to get physicians into programs.”

Surgery Grows

The increases across the board also apply to the field of surgery, which continues to experience remarkably high match rates, with each discipline greater than 99% (see Table 1).³ And, importantly, interest and position availability also remain high and are often growing.

“The trend is that we’re getting more applicants who are interested in surgery, and with that every year there have been an increased number of positions available to applicants,” said Jennifer Serfin, MD, FACS, a general, critical care, and trauma surgeon, as well as a designated institutional official at Good Samaritan Regional Medical Center in Corvallis, Oregon.

The NRMP numbers bear out these observations, especially when looking back farther than 2023. In general surgery (designated as “Surgery: Categorical” within the NRMP data), for example, 1,717 positions were offered across the US in 2024, and 1,712 were filled, representing a 99.7% match rate. The open positions grew modestly from the 2023 Match, which offered 1,670 positions.³

But compared to 2020, the growth is more noticeable, as 1,536 positions were offered that year—meaning that positions offered have increased by nearly 12% since only 4 years ago (see Table 2 for growth between 2020 and 2024).³

All other surgery disciplines experienced growth in this timeframe as well, showing that surgery is an enduring career path. For example, the number of offered obstetrics-gynecology positions was 1,539 in 2024 versus 1,443 in 2020; orthopaedic surgery grew to 916 positions in 2024 versus 849 in 2020; otolaryngology was 382 in 2024 versus 350 in 2020; and so on.

The Match numbers show that interest and trainee participation in surgery is healthy and, as Dr. Lamb notes, “Match data are a critical bellwether of the future physician workforce.” So, while the field is growing, is it growing fast enough to meet the needs of the US population?

Surgeon Workforce and Distribution

The NRMP Match data for 2024 indicate that the number of surgeons in training is trending upward over time, which is positive.

However, when reviewed in the context of recently released physician workforce data from the Association of American Medical Colleges (AAMC), questions arise about how the number of positions available is reflecting the need for surgeons. A recent report on the AAMC findings in the Bulletin noted that there is a projected shortage of 13,500 to 86,000 physicians in the US by 2036—and this includes a projected shortage of 10,000 to 19,900 surgeons.⁴

Compared to the shortfall, the current rate of growth for surgery positions, while significant, may not be enough to compensate.

“The increase in the number of positions and applicants interested in surgery is all definitely positive, but whether we’re going to catch up to the need is questionable,” said Dr. Serfin.

The challenge of addressing the shortfall via residency goes beyond sheer numbers. Specifically, there is an issue with the geographic maldistribution of surgeons, which is in part reflected in training.

Using general surgery as a reference point, in states that have large urban populations, such as New York, California, Texas, and so on, the number of available positions and programs is considerable. New York offered 381 positions in 2024, California 234, and Texas 192.³

Meanwhile, predominantly rural states such as North and South Dakota offered eight and four positions, respectively, while Idaho, Montana, and Wyoming offered no surgery residency positions at all, despite being home to, combined, millions of people.³ While this has potential implications for permanent practice after residency, where there is a slight preference for remaining in the state of training for licensed practice,⁵ it also contributes to a decreased healthcare workforce in areas already affected by lower access to surgeons (see Table 3).

Working Together

The NRMP plays an indispensable role in transitioning medical school graduates to their residency practice locations and, therefore, replenishing and growing the eventual practicing physician workforce across the US, but it is not the role of the NRMP to create new residency programs or positions.

The NRMP itself has oversight of the time that people begin applying for residency through the 45th day after their start of residency programs to ensure that this transition takes place, that applicants maintain their binding commitment, and that applicants move into the programs they are supposed to be moving into so that there is sufficient training across the US, with as equal distribution as possible.

The work of addressing the future workforce is performed in tandem with the AAMC, which collects and disseminates valuable student and workforce data and administers the Medical College Admission Test, among other roles, and with the Accreditation Council for Graduate Medical Education (ACGME), which accredits all residency training programs in the US. But there are limits to what the organizations can do.

“No group has the authority to mandate to the ACGME, for example, that they need to create a practice location or specialty in an area of need, or that certain specialty positions are needed in a given area,” Dr. Lamb said. New institutions or programs are assessed on their merits based on minimum common program requirements and specialty requirements, regardless of location.

Addressing these needs and identifying solutions will require engagement and partnership with government entities, and there is action taking place on that front, Dr. Lamb noted.

Representatives Terri Sewell (D-AL) and Brian Fitzpatrick (R-PA) last year introduced legislation to the US House of Representatives, the Resident Physician Shortage Reduction Act of 2023, that would expand the number of Medicare-supported medical residency positions by 14,000 over 7 years.⁶ While this would still only barely address the lower-end projections of the AAMC-projected physician shortage, it would represent a significant increase.

Dr. Lamb suggested the other way the government can play a role is by formally identifying areas of need for physicians and surgeons and then allocating the additional positions in a way that benefits population health.

“The conversation is going to need to include every organization and some of the congressional leaders that can help figure out how we can address a physician shortage in a way that’s equitable across the country,” she said.

The ACS has a role to play for surgery, supporting relevant legislation such as the Ensuring Access to General Surgery Act of 2023. This legislation would allow “the Health Resources and Services Administration to study and define general surgery workforce shortage areas and grant the Secretary of Health and Human Services the authority to provide a general surgery shortage area designation.”⁷

Role of Surgery Program Directors

The number of available residency positions in the US, the rate at which they are filled, and conversion into practicing physicians in areas of need is addressed in national-level dialogue, but surgery program directors can play a part in helping to guide their trainees.

“I think that potentially pivoting some of our training and mentoring of our trainees to seek positions and locations where there are deficiencies in surgeons, as well as maintaining and supporting the workforce through emphasizing well-being, can have an impact on our workforce challenges,” Dr. Serfin said.

While individual surgery program directors have the responsibility to grow and maintain their programs, broader organizational support can be significant. The Association of Program Directors in Surgery (APDS), for which Dr. Serfin serves as the recruitment taskforce chair, supports program directors, and provides resources to help guide their decision-making, including keeping track of surgery residents matched by the NRMP.

Particularly in general surgery, “we try to emphasize matching the right resident to the right program because the specialty has such a wide variety of programs and opportunities, so support needs to be offered on a case-by-case basis,” Dr. Serfin said.

She explained that a smaller program like Samaritan, where she practices, tends to focus more heavily on bread-and-butter general surgery training, with exposure to multiple specialties, and that fosters an environment where residents are ready and able to practice at the time of graduation. The program developed a high percentage of graduates who go into general surgery practice, rather than fellowship, which differs from the output of larger, more urban programs. For reference, Oregon offered 27 general surgery residency positions in 2024.³

This difference is both a benefit to training in a smaller, rural program, but also represents a challenge.

“We need to create an educational environment where we foster interest in rural practice or in filling those positions that are in need without stifling clinical interest, and the interest of furthering training,” Dr. Serfin said.

Another pragmatic challenge that is becoming more pressing is the volume of applications. The number is often increasing more quickly than the capacity to review them thoughtfully and intentionally, she noted, adding that some programs receive 400–600 application for two spots, while others receive more than 2,000 applications for their positions.

Depending on the size of the recruitment team at the institution, it can be challenging to review those applications in a holistic manner that considers the unique characteristics of candidates. And the APDS encourages a holistic approach to application review.

“Program directors are all encouraged to thoughtfully consider applications based on how the applicant would fit into their program and what the program can offer them,” Dr. Serfin said. “The limitation to that holistic review is the time it takes while dividing time among applications.”

Tools to aid in processing applications exist, but the growing numbers of applicants being processed through the NRMP is a factor that may need to be addressed to make the process more efficient for surgery program directors.

Looking Ahead

The NRMP’s position as the organization responsible for matching most US residents to their training programs affords it a chance to gather data that make the matching process increasingly useful to programs and communities alike.

According to Dr. Lamb, one of the key ways that the organization will increase its impact is by collating and, eventually, releasing demographic and professional information on its applicants.

“We are trying to provide information to medical schools, institutions, and programs so they can look at their mission, aims, and competitiveness, and determine whether or not the actions that they’re taking to attract the type of residents they want or need for their programs and community are actually working,” she said, explaining that this information will “allow applicants a more comprehensive understanding of how they align with the program they want to be in.”

Currently, applicants often find themselves in a “black box” of information when determining whether a program is the right fit for them, but demographic data for programs or specialties will allow applicants to take a more active role determining their compatibility. For programs, the data will show the gaps and opportunities that exist to help ensure equity in employment of individuals representing all racial, gender, sexual, and disability identities.

Generating this kind of demographic data is a large-scale effort, and the NRMP expects to begin releasing a series of comprehensive data reports to the public in late 2026 or early 2027. As of this article’s publication, the organization currently has available on its website a charting tool that contains demographic data for the 2022, 2023, and 2024 matching residents.⁸

On the horizon, one initiative for the NRMP includes a pilot for a voluntary rank order list lock for programs to finalize their lists, which demonstrates to applicants that no changes will be made in their rankings after an in-person visit by the applicant. Another initiative is a joint study with the AAMC to determine whether preference signaling—the ability for candidates to signal interest in individual residency programs by specialty—has any effect on ranking or matching.

Ascertaining and studying this information may help to bolster the residency programs by getting trainees to the places they want to be and where they will find success, in the most effective manner possible.

The process will continue to be refined, but the 2024 Match numbers and trends indicate that resident surgeons are entering into a thriving and competitive profession.

Matthew Fox is the Digital Managing Editor in the ACS Division of Integrated Communications in Chicago, IL.

References

1. NRMP^® Celebrates Match Day for the 2024 Main Residency Match^®, Releases Results for Over 44,000 Applicants and Almost 6,400 Residency Programs. NRMP. Published March 15, 2024. Available at: https://www.nrmp.org/about/news/2024/03/nrmp-celebrates-match-day-for-the-2024-main-residency-match-releases-results-for-over-44000-applicants-and-almost-6400-residency-programs/. Accessed June 5, 2024.
2. Match Day 2024 results: NRMP match rates by specialty, SOAP match statistics, plus Match Day 2025. American Medical Association. Published March 22, 2024. Available at: https://www.ama-assn.org/medical-students/preparing-residency/match-day-2024-results-nrmp-match-rates-specialty-soap-match#:~:text=A%20total%20of%202%2C575%20positions. Accessed May 9, 2024.
3. Advance Data Tables, 2024 Main Residency Match^®. NRMP. Available at: https://www.nrmp.org/wp-content/uploads/2024/03/Advance-Data-Tables-2024.pdf. Accessed May 9, 2024.
4. Newman MS. Physician Workforce Data Suggest Epochal Change. Bulletin of the American College of Surgeons. 2024;109(4):28-33. Available at: https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2024/april-2024-volume-109-issue-4/physician-workforce-data-suggest-epochal-change/. Accessed May 9, 2024.
5. Table C6: Physician Retention in State of Residency Training, by State. AAMC. Available at: https://www.aamc.org/data-reports/students-residents/data/table-c6-physician-retention-state-residency-training-state#:~:text=Selected%20Finding%3A%20Overall%2C%2054.2%25. Accessed May 9, 2024.
6. Reps. Sewell, Fitzpatrick Introduce Bipartisan Legislation to Combat Physician Shortage and Improve Access to Health Care. U.S. Congresswoman Terri Sewell. Published March 29, 2023. Available at: https://sewell.house.gov/2023/3/reps-sewell-fitzpatrick-introduce-bipartisan-legislation-to-combat-physician-shortage-and-improve-access-to-health-care. Accessed May 9, 2024.
7. Surgical Workforce. ACS. Available at: https://www.facs.org/advocacy/federal-legislation/surgical-workforce/. Accessed May 16, 2024.
8. Charting Outcomes: Demographic Characteristics of Applicants in the Main Residency Match and SOAP. Tableau.com. Published 2024. Available at: https://public.tableau.com/app/profile/national.resident.matching.program/viz/NRMPDemographics3_0/TableofContents. Accessed May 16, 2024.