Comparing Match Outcomes in a Surgical Subspecialty: Independent Versus Integrated Training Pathways

Abstract

In recent years, the Thoracic Surgery Match (TSM) has become increasingly competitive. The purpose of this study was to compare recent trends in application and match rates in the TSM by training pathway. This was a retrospective cohort study of all applicants to Integrated and Independent pathways for Thoracic Surgery training (2008-2021). Chi square tests were used to elucidate temporal trends and make comparisons by training pathway. Accreditation Council for Graduate Medical Education (ACGME)-accredited Thoracic Surgery training programs in the United States. 1500 Independent and 1242 Integrated pathway applicants for Thoracic Surgery training. From 2008 to 2021, the annual match rate decreased from 91% to 71% in the Independent pathway (p < 0.001). This was driven by a decrease in the number of training positions (130-101, 22% decrease) and increase in number of applicants (96-140, 46% increase). In the Integrated pathway, the annual match rate increased from 33% to 35% (p < 0.001) as did the number of training positions (3 to 46, 1430% increase) and applicants (9-129, 1333% increase). During each year, match rates in the Independent pathway exceeded those in the Integrated pathway (p < 0.001). U.S. Allopathic graduates had higher match rates than non-U.S. Allopathic graduates for both Integrated and Independent training pathways. The percentage of applicants in the Independent pathway matching at one of their top 3 choices decreased from 73% to 40% (p < 0.001). The percentage of Independent thoracic surgery training positions that went unmatched decreased from 28% to 2% (p < 0.001). This percentage was stable at an average of 1% in the Integrated pathway (p > 0.05). The TSM has become increasingly competitive for Independent pathway applicants and remains ultracompetitive for Integrated pathway applicants. More research is needed to understand disparities in match rates by Thoracic Surgery training pathway.