Analysis of application and match rates for clinical cardiac electrophysiology training in the United States

Background Waning interest and 2 additional years of fellowship training may be barriers to recruiting applicants to fill available training positions in clinical cardiac electrophysiology. Objective To understand changes in the annual number of training positions and applicants in clinical cardiac electrophysiology, match rates, unfilled training positions, and where applicants matched on their rank lists. Methods This was a cross-sectional analysis of all applicants for clinical cardiac electrophysiology training from 2019 to 2025. Match rates and applicant-to-training position ratios were calculated. Temporal trends were assessed with linear regression. Results Growth in the annual number of applicants (89–177, 99% increase) exceeded growth in the number of training positions (130–152, 17% increase) ( P < .001). Accordingly, the annual applicant-to-training position ratio increased from 0.7 to 1.2 ( P < .001). During each year, match rates for US allopathic graduates exceeded those for non-US allopathic graduates ( P < .001). There was a significant growth in the number of submitted ranks per applicant (5.6–9.1 ranks, P < .001) and fewer applicants matched at 1of their top 3 fellowship choices over the study period (84%–61%, P < .001). Fewer available annual training positions went unfilled from 2019 to 2025 (38%–2%, P < .001). Conclusion Growth in the annual number of applicants for electrophysiology training exceeded growth in the number of available training positions, whereas match rates and the number of annual unfilled training positions have decreased. Although these trends are encouraging, future surveillance is warranted given projected shortages in the cardiac electrophysiologist workforce.