Over the last decade, the rapid growth of hospital medicine has raised concerns that fewer graduating internal medicine (IM) residents might be pursuing fellowship, including in ID. We analyzed national trends in applications to subspecialty fellowships over the last 10 years to examine the potential impact of hospital medicine on resident career choice.
We examined 2009-2018 data from the National Resident Matching Program Specialties Matching Service for applicants to 8 IM subspecialties. The number of third year residents (R3s) was obtained from the American Board of Internal Medicine Resident Workforce Data.
The number of matched applicants increased significantly over the last ten years from 2889 to 3640 (p<.0001) and was highly correlated with the increase in number of R3s (r2=.93, p<.001). All subspecialties saw a significant increase in matched applicants over time except ID and nephrology, which both saw initial decreases that reversed after converting to an “all-in” match. In 2018, ID had its highest number of matched applicants in the last 10 years.
Despite concerns that the growth in hospital medicine would lead to fewer IM residents pursuing subspecialty fellowship, the number of matched applicants to subspecialty fellowships has actually increased over the last 10 years and has kept pace with the growth in R3s over this time. Initial decreases in the number of matched applicants in ID have now reversed after conversion to the “all-in” match, and the next few years will be critical to determine if this trend continues.
 Santhosh L, Babik J, Looney MR, Hollander H. Whither the Pulmonary Ward Attending? Preserving Subspecialty Exposure in United States IM Residency Training. Ann Am Thorac Soc. 2017 Apr; 14(4):565-568.
 Bonura, E. M., & Armstrong, W. S. (2017). Increasing Subspecialization in the Field of Infectious Diseases: Evaluating Challenges and Strategies to Move Forward. The Journal of infectious diseases, 216(suppl_5), S594-S599.
 National Resident Matching Program, Results and Data: Specialties Matching Service 2009-2018 Appointment Years. National Resident Matching Program, Washington, DC. 2009-2018.
 American Board of Internal Medicine. Resident and Fellow Workforce Data, 2018.