Publication Race: The Battle for Residency in a Competitive Landscape.

Research plays a significant role in the residency match, particularly after the United States Medical Licensing Examination Step 1 changed from a score-based exam to pass/fail scoring. This study shows the impact of research on the match between 2009 and 2024, categorized by specialties and residency competitiveness. Residency specialties were categorized according to competitiveness (high, medium, and low), according to the Association of American Medical Colleges. The data were analyzed using descriptive statistics, paired-samples t-test, two-way repeated measures analysis of variance, and post hoc pairwise comparisons with Bonferroni correction to examine differences in research experiences and outputs across specialties. The total number of US senior applicants increased from 14,697 in 2009 to 18,801 in 2024, with US-matched applicants rising from 13,453 to 16,891. The overall match rate did not significantly change. Research experiences and outputs significantly increased, with the mean number of research experiences rising 180% (2.44-4.38; P < 0.001) and publications 365% (3.82-13.98; P < 0.001). Analysis of variance showed that highly competitive specialties had the largest increases in both research experiences, 195% (3.03-5.92; P < 0.001) and publications, 405% (5.46-22.14; P < 0.001). Our study showed that research has become increasingly essential to the match, particularly in highly competitive specialties. Our findings illustrate the key priorities in residency applications and demonstrate the expanding importance of research within the match.