Postgraduate Medical Education

Almost all graduates of U.S. and Canadian medical schools secure internship appointments in U.S. hospitals through the National Resident Matching Program (NRMP). More specifically, in a recent year, 93% of about 14,300 U.S. senior medical students who participated in the NRMP received a first-year residency position. This reverses the trend for placement in proceeding years. Foreign medical graduates are eligible to participate if they have passed the USMLE in September or earlier. In recent years, the number of foreign medical graduates participating in the Matching Program significantly increased. They filled almost all of the 500 residency slots that were offered.

Currently, about 50,000 residents are training at U.S. civilian hospitals. The number of residency slots has increased slightly in recent years, particularly in the fields of anesthesiology, internal medicine, and, to a lesser degree, psychiatry and emergency medicine. There were decreases in positions for residents in the fields of pathology and plastic surgery.

In the fall of the senior year, all medical students apply to the hospitals to which they would like an appointment. Sometime during the winter, after the students' marks have been submitted to the hospital residency program director, they may be invited to visit the hospital where they will be interviewed by one or several attending physicians as well as the director of the training program. After the interviews are completed in the early spring, prospective interns make up a list of hospitals to which they have applied, with the number one choice at the top, the last choice at the bottom. All the participating hospitals submit similar lists of the students they have interviewed. The lists are gathered in a central office and fed into a computer, and pairings are made. The seniors' preferences are then matched with the hospitals' preferences. This program, which was instituted in 1952, avoids a great deal of chaos and anguish, since previously neither students nor hospitals knew where they were until the last moment. The match rate for U.S. medical graduates is usually higher than 90%.

All specialty boards have made significant modifications in their requirements to adjust to the plan for integrated postgraduate training; senior medical students may now apply for a first year of graduate medical education (PGYI), either in one of the existing types of “internships” or in a first year of residency in most specialties. For additional information contact: National Resident Matching Program, 2450 N Street NW, Suite 201, Washington, DC 20037.

The current average salaries for residents are in the $25,000 to $50,000 range. However, as a result of the deterioration of their financial status because their salaries have not kept up with inflation and their education indebtedness has increased, many residents hold second jobs. Married people, especially those with children, are the most likely to be forced to supplement their incomes by “moonlighting”—working at outside jobs.

The rate of annual increase in house staff (resident) salaries has been growing slowly over the past few years. Some hospitals have not increased their stipends at all, and a number have even decreased them. In general, pay increases are higher at hospitals located in the Northeast and lowest for those in the South. Also, the pay for house staff at university-owned hospitals, because of their higher status as teaching institutions, tends to be lower than the national average, while that for hospitals with limited university affiliation tends to be higher.

Most hospitals offer health insurance for house staff and their dependents as part of the benefit package. Vacation time varies from one to four weeks annually with the amount increasing by the number of years of training.

Currently, somewhat more than half the hospitals have maternity leave policies but the types of programs vary considerably. One-third of the hospitals treat maternity leave as sick leave, another third have specific guidelines, and the others consider it as short-term disability leave, without pay or vacation.