Trends in Otolaryngology Match Dynamics Before and After the USMLE Step 1 Pass/Fail Transition.

Abstract

To evaluate otolaryngology (ENT) residency match trends before and after the USMLE Step 1 transition to pass/fail. Observational longitudinal analysis of annual, publicly available specialty-level data (2010-2025). National Resident Matching Program (NRMP). Data from 2010 to 2025 were used to calculate applicants per PGY-1 position, fill rate, and nonmatch-in-specialty rate. ENT was compared with plastic surgery, orthopedic surgery, neurological surgery, and general surgery. We used ordinary least squares (OLS), segmented regression with a 2023 breakpoint, and difference-in-differences (DID) models. From 2010 to 2025, ENT programs increased from 105 to 139 and positions from 280 to 394. Applicants per position ranged from 1.06 to 1.60 (mean 1.38). OLS showed no significant long-term trend in applicants per position (+0.002/year, P = .86), fill rate (+0.03 percentage points/year, P = .68), or nonmatch-in-specialty rate (+0.04 percentage points/year, P = .94). Segmented regression showed no significant post-2023 changes in applicants per position (slope change +0.03/year, P = .78), and no significant changes in applicant counts (P = .7). ENT had the largest 2022 to 2023 decline in this cohort, in both applicants (-14.1%) and applicants per position (-16.9%). However, in two-way fixed-effects DID models, there was no ENT-specific post-transition change in applicants per position (P > .05 in primary and sensitivity analyses). ENT remained highly competitive but trend-stable from 2010 to 2025. Although 2023 showed a notable drop in applicants, we found no consistent evidence of a sustained ENT-specific competitiveness shift after the Step 1 pass/fail transition.