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Objective:
Diagnostic radiology experienced decreased applications from US allopathic seniors during the midportion of the 2010s. Sparked by increased job availability for radiologists, applications increased by 2018. An additional level of complexity was borne at this time with the emergence of integrated I\interventional radiology (IR/DR) programs which became immediate competitors to Diagnostic Radiology (DR) programs. The purpose of this investigation was to characterize the state of competitiveness of DR in the setting of competition from IR/DR and assess for any subsequent impact on the American Board of Radiology (ABR) Core examination pass rates.

Materials and Methods:
Publicly available data from the National Resident Matching Program (NRMP) and the ABR were analyzed using descriptive statistics. Trends in USMLE Step 1 scores of matched applicants to all NRMP specialties were characterized via linear regression.

Results:
Regression analysis demonstrates that DR USMLE 1 scores remained relatively flat with an increase of only 1.23 points per year since 2005, the lowest rate of increase among specialties that utilized the NRMP during that time. By contrast, physical medicine and rehabilitation saw the fastest growing mean USMLE 1 score for matched applicants at a rate of 2.88 points per assessed year since 2005. Total applicants per position for DR decreased from 1.4 in 2009 to 1.04 in 2016 prior to returning to 1.36 in 2022. Despite these changes, the average USMLE step 1 score remained relatively constant at 238-241 between 2009-2016, with an increase to 245 by 2022. The percentage of DR residents matching with membership in Alpha Omega Alpha (AOA) decreased from 26.4% in 2011 to 15.8% in 2018 (19.3% in 2022), with IR/DR exhibiting AOA membership between 20.8% and 30.5% since 2018. With less than 200 IR/DR positions nationwide, IR/DR is now one of the most competitive specialties in the match, and data suggest that matched IR/DR applicants represent a more competitive subset of applicants interested in radiology, though IR/DR decreased from 1.86 applicants per position in 2018 to 1.34 in 2022. Although the number of IR/DR plus DR positions was 1324 in 2022, an increase from 1018 in 2005, the percent of total positions held by DR and IR/DR decreased from 5.23% in 2005 to 3.71% in 2022. The ABR Core examination first-time pass rate reached a nadir of 84% in 2018 representing the class that matched in 2014 with a mean USMLE 1 of 241. The mean USMLE 1 of matched DR applicants in 2018 decreased slightly to 240, likely owing to competition from IR/DR, as the USMLE 1 of matched IR/DR applicants was 246. The ABR Core examination pass rate rebounded to 94.5% in 2022.

Conclusion:
DR has become less competitive since 2005, with competition from IR/DR likely impacting objective indicators of specialty competitiveness. DR and DR+IR/DR positions have not increased at the same rate as other specialties utilizing NRMP. When assessed as a means of whole classes taking USMLE 1 and the ABR Core examination, there is poor correlation between mean USMLE 1 score and overall ABR Core examination pass rate.