A new Yale University study of residency programs across the U.S. found that medical students who report having a disability are less likely to be matched into a residency program.
The researchers said the findings suggest that students with disabilities may experience barriers to training and career opportunities, particularly in certain health care specialties.
“There is a shortage of physicians with disabilities in the medical field,” said Mithien Nguyen, an MD-PhD student at Yale School of Medicine and lead author of the study. “Low match rates exacerbate this disparity, which could ultimately have a negative impact on the medical field and patient care.”
For the study, published April 17 in JAMA, researchers used data from the National Resident Matching Program, which matches applicants to residency programs across the U.S. They analyzed the match outcomes for individuals applying to residency programs in 2022 and 2023.
Of the roughly 70,000 people who applied for housing during that period, 5.9% declared they had a disability, answering “yes” to the question on their application: “Are you disabled (e.g., ADHD, learning disability, psychological disability, chronic health condition, mobility impairment, hearing impairment, vision impairment, etc.)?”
The researchers evaluated match rates between those who reported a disability and those who did not and found a small but significant difference in match rates: 83.2% of those who did not report a disability were successfully matched to a residency program compared with 81.8% of applicants who reported a disability.
When the researchers looked at rates across medical specialties, they found several specialties where match rates were not significantly different between the two groups. However, other specialties, including ear, nose and throat, neurology, physical medicine and rehabilitation, dermatology, pediatrics, internal medicine, and emergency medicine, had higher match rates for applicants with disabilities.
The overall lower match rate for students with disabilities was due to general surgery having a match rate of 65.5% compared to 76.2% for students who did not report a disability, and orthopedic surgery having a match rate of 58.6% compared to 73.3% for students who did not report a disability.
In the matching process, students apply to specific programs, are interviewed, and rank the programs according to their priority. The programs also rank the applicants, and the National Resident Matching Program uses an algorithm to determine matches based on the two rankings.
The researchers say that variation in match rates across specialties may reflect differences in speciality cultures and how applicants are evaluated, and that conscious or unconscious biases may influence match rates.
“Given this gap, I think it’s important for each specialty, not just surgical specialties, to think about their own processes and incorporate disability as a screening criterion in addition to race, ethnicity and gender when assessing the diversity of their programs,” Nguyen said.
Differences between specialties may also point to positive approaches that others can adopt or build on, said senior author Dawin Boatright, now vice chair of research in the department of emergency medicine at NYU Grossman School of Medicine, who began the study while at Yale University School of Medicine.
“Looking at specialties that have a higher match rate for applicants with disabilities may provide effective strategies for fair evaluation,” he said.
Nguyen said organizations like the Accreditation Council for Graduate Medical Education, which evaluates medical training and internship programs, also have a role to play, noting that the group is already working to promote awareness and support for learners with disabilities.
“And of course, the number of applicants with disabilities in our survey was very low, which speaks to the fact that disparities may exist early in the training process and that these also need to be addressed,” she said.