Introduction

The Urology Residency Match Program (the Match) is overseen by the AUA in conjunction with the Society of Academic Urologists. The urology Match remains highly competitive within the field of medicine with an average match rate of 71% from 2006 to 2022. The competitiveness of the urology Match is repeatedly demonstrated during its annual match cycle, most recently with 34% of applicants in 2022 not successfully matching.¹ The competitive nature of the urology match is beneficial, as this highlights continued interest in the specialty and allows programs to recruit the most qualified applicants. However, there is limited analysis of how the characteristics of the urology match have changed over the past decade. This study aims to examine the Match and match trends from the years 2006 to 2022.

Methods

Aggregate level match statistics by year from 2006 to 2022 were obtained from the AUA. Match data were analyzed for trends of application numbers, available positions, applicant demographics, and match rates from 2006-2022. Available applicant demographics include gender (male or female), international medical graduate, senior U.S. MD, and non-senior U.S. MD.

Results

Between 2006 and 2022, 6,953 applicants submitted rank lists to the AUA Match, with an average match rate of 71%. There was a 58% increase in the number of applications per year from 350 in 2006 to a high of 556 in 2022. During this time frame, the available residency positions have increased by 55% from 235 to 365. The average number of applications received by urology programs increased from 149 to 347, while the mean number of applications submitted per applicant also increased from 39.5 to 82. Between 2006 and 2022, the proportion of females in the urology applicant pool increased from 21% to 32%, as the total number of female applicants increased from 74 in 2006 to a high of 180 in 2022. Overall, the total number of female applicants increased by 243%. The average match rates for the 5 demographics that the urology Match divides applicants into were as follows: U.S. MD seniors 78%, non-senior U.S. MD 48%, international medical graduate 26%, female applicants 73%, and male applicants 71%.

Discussion

Between 2006 and 2022, there was a cyclical pattern between match rates, which corresponded to the number of applicants and the number of available residency positions each year. There is no clear evidence on what drives the fluctuations in the number of applicants, but subtle changes are to be expected based on prior year match rates. However, with an average of 29% of students unmatched in urology, clear evidence of continued attractiveness of the specialty remains.

The competitive nature of urology highlights the importance of thoughtful recruitment to attract the most qualified applicants. One important consideration involves the demographics of applicants, including gender and underrepresented minorities, as this directly impacts the future urologic workforce. This is particularly relevant when addressing the expected workforce shortage. Based on the 2019 AUA Annual Census and the U.S. Census data, the projected workforce shortage in urology is 46% by year 2035 given the current number of urologists per capita and the expected demand of urological services by the general population.²

Regarding the current workforce, urology, as many surgical specialties, has historically been a male-dominated field. According to an analysis of the National Graduate Medical Education Census data, from 2007 and 2018, women were underrepresented in surgical programs compared to the overall female trainee population. The specialties with the lowest representation included urology, otolaryngology, plastic surgery, orthopedic surgery, and neurosurgery.³

Female urology applicants have dramatically increased from 21% of applicants in 2006 to 32% of applicants in 2022. This is also reflected in the increasing percentage of females who successfully match into urology residencies. Prior to 2020, the match rates between male and female applicants were similar. However, since 2020, a gap in match rates by gender widened (see Figure). Currently, only 9.9% of practicing urologists are currently female.² However, nearly one-third of urology residents are female, and thus the expected number of female practicing urologists will continue to rise.⁴

Prior reports have shown that specialties with the lowest proportions of female faculty, including urology, neurosurgery, and orthopedic surgery, have exhibited the slowest growth in the proportion of female residents.^5,6 The projected shift in the demographics of urology workforce highlights the need for thoughtful approaches to support female urologists including mentorship, purposeful recruitment, and advocacy among urology leadership.⁷ The AUA has made initiatives to support women in urology including mentorship and sponsorship for women to advance academically and in leadership roles. Sponsorship not only provides the opportunity for female advancement, but it also facilitates continued mentorship for female medical students.⁸ Connecting students to mentors with similar demographics, including gender, has been found to have a positive impact on medical student interest and can further support females in urology.⁹

Another important consideration is to evaluate the trends of underrepresented minorities in urology. A 2019 study found that there was a significantly lower proportion of underrepresented minorities among urology residents (30.8%) in comparison to other surgical fields (33.6%) and all medical residency fields (42.3%). This trend is further seen amongst underrepresented minorities in urology leadership, in which recent data show only modest representation in department chair and program director roles.^10,11 Developing leadership begins with the applicant pipeline. An initial strategy to understand this involves collecting specific race and ethnicity data within future Match statistics.

Conclusion

The urology Match remains highly competitive with an average match rate of 71% between 2006 and 2022. The increase in female applicants and successful matches supports the goal of increasing future workforce participation. The expected changes in urology workforce highlight the need for purposeful recruitment, mentorship, and advocacy to support female urologists. In addition, this is a call to include race and ethnicity data in future Match statistics.