Interviewing for residency positions while completing a graduate degree: Considerations for graduate students, mentors, and program directors (2022)

The pipeline of new clinical medical physicists in the United States includes graduate education followed by residency training. A major bottleneck occurs as students on the verge of completing their advanced degree programs seek positions in residency training programs; for example, in 2022 between a quarter and a half of applicants did not enter residency training.[11 For the intents and purposes of this editorial, we require only a crude bracket around the true value, which is not known. We took data on the MedPhys Match (run by National Matching Services [NMS] for positions beginning in 2022).13 These data reveal that 133 of 264 (50%) of applicants matched to a residency. However, only 214 applicants participated in the match, and of those only 180 were ranked by at least one program (NMS calls this subset ranked applicants “acceptable” applicants; we use this term for consistency; be noted th-at we are unable to confirm that ranked applicants are acceptable or unranked applicants are unacceptable). A total of 133 of 180 (74%) of acceptable applicants matched to a residency program. Hence, these data suggest a bracket spanning 50%–74% of applicants, depending on the denominator selected. For comparison, according to the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), 323 students graduated from accredited programs in 2020 (a figure which excludes nine graduates from DMP programs),19 of which at least 50% applied to residency programs. We speculate that the reason for which the AAPM's value is larger than that from CAMPEP is that the former includes a backlog of frustrated applicants (who completed their degree in previous years and are attempting admission a second or higher time), whereas the latter excludes these individuals. ] The origin of the bottleneck was the introduction in 2014 of the American Board of Radiology's eligibility requirement for professional board certification that mandated the completion of an accredited residency program.1 The bottleneck acutely impacts graduate students. Impacts of concern include anxiety and depression, which are prevalent in graduate students across a spectrum of disciplines in the United States.2 Other potential impacts include shortages of qualified medical physicists, which could in turn impact the quality, safety, and availability of patient care.3-7 Although there is literature on navigating the medical physics education and training pathways,8-10 there is little guidance for graduate students in balancing their limited time to be spent on the competing tasks of interviewing for a residency position and simultaneously completing their degree. In principle, this should be quite simple: Each student interviews with enough residency programs to successfully secure an offer of admission to at least one program, but the number of interviews should not impact the completion of the graduate degree. In practice, the bottleneck problem makes it difficult for a student to estimate this number with confidence. Many students have managed this uncertainty by applying to, and interviewing with, large numbers of residency programs.11 Excessive time spent interviewing, however, can negatively impact students, faculty, and education and training programs. A recent study12 suggests that the bottleneck problem could contribute to stress and burnout. For all these reasons, we seek to raise an awareness of key factors that students and their faculty mentors should consider as they navigate through the bottleneck. Solutions to the bottleneck are beyond the scope of this editorial; rather, we seek to provide information and guidance to facilitate navigating the system, as it currently exists. Guidance is provided as suggestions for consideration, and they should not be construed as requirements. All students complete their degrees on time. All students who are admitted to a residency training program begin on schedule. Students and programs spend an appropriate amount of time interviewing; this time should be sufficient to make informed and wise decisions but not excessive to distract from other responsibilities. All residency programs utilize their full training capacity by successfully recruiting residents to all open residency positions. All qualified students who wish to enter a residency training program are able to do so, and all residency graduates subsequently enter the clinical medical physics workforce.[22 To reach this nirvanic state, graduate degree program admissions in a given year would have to equal future demand for residency graduates (in each subspecialty), for example, 4–5 years hence for MS degree holders, 7 or more years for PhD holders, and 1–2 years for postdoctoral certificate holders. Graduate admissions targets and workforce projections are challenging problems that are beyond the remit of this editorial. ] Late completion of a degree. Deferral or cancellation of admission to residency program due to delay in degree completion. Failure of qualified students to gain admission to a residency training program. Vacant training positions in accredited residency programs (10 of 133, or 7%, of positions to begin in 2022 were unmatched).13 Anxiety and depression of students due to the residency interview process. Making good choices regarding one's education, training, and career is complex under the best of circumstances. Currently, a large number of applicants are not able to enter residency training programs. Navigating these turbulent waters calls for well-informed, rational, and responsible decision-making by students, mentors, graduate education programs, and residency training programs. Personalized decision-making is essential because the characteristics and goals of individual students and programs are diverse. We discourage prescriptive approaches, such as recommending a maximum number of interviews per student or per residency opening. Lastly, we recommend continued annual surveillance by the education community to monitor this serious and evolving situation. We thank John Antolak, Kristi Hendrickson, Ishmael Parsai, Anthony Doemer, Elizabeth Park, Beth Schueler, and Kenneth Matthews for helpful discussions. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the material reported. Wayne Newhauser drafted the manuscript and provided project leadership. Each of the coauthors contributed intellectual content and edited the manuscript.