Past, Present, and Future on the Residency Match & Some Last Minute Tips with 48 hours to go
Every 4th year medical student you know is making a list and checking it twice. This is because rank lists are due to the National Resident Matching Program (NRMP) on Wednesday February 22rd 2012 at 9pm EST.
The history of the Match is actually very interesting. Historically, physician training in medieval days was arranged when craft guilds matched apprentices with physician masters for their training. Modern history of the US Match actually describes the situation where hospitals were pressuring students as early as 2nd year to sign up for internship before students knew where else they were competitive for and before hospitals had adequate information about student clinical performance. In 1952, when the match was first proposed, medical students actually protested the initial algorithm since it penalized students for ranking a hospital who did not want them. The students proposed the alternate algorithm, the “Boston Pool Modification,” which favored students rank preferences and was ultimately adopted. Since that time, the growing number of preliminary positions and the need for a couples match has led to redesign of this algorithm, but always preserved favoring the student.
More recently, the Match has persevered in the face of a recent lawsuit that which accused the Match of violating the nation’s antitrust law. The Supreme Court ultimately dismissed the case due to an amendment that was made to antitrust law that exempted the Match. While the lawsuit painted the NRMP as the evil player, the Court actually concluded that the NRMP and the hospitals’ participation in the Match “are so interdependent that the Court cannot separate them” in the allegations. One benefit of the match is students are able to make decisions on a standard schedule, without being pressured to commit to a program prematurely. Both applicants and programs must sign a Match Participation Agreement (MPA), which states that one party cannot solicit a commitment from the other or suggest that ranking is contingent on such a commitment. Despite this, there is recent concern that these agreements are being violated.
Today, the Match has become even more competitive as the number of US medical graduates has increased with new medical schools and expanded class sizes (a result of the call by the AAMC) while the number of residency slots across the nation remains constant. Leaders in medical education project that without any increases in residency spots, the number of US medical school graduates will eventually surpass residency spots in 2016. While calls for increased residency spots continue, for the moment, strategy to optimize successful matching has become increasingly important for US students. (Update: 2012 is the first year of the “SOAP” or Supplemental Offer and Acceptance Program that will take the place of the prior Scramble. It is also the first day in recent memory Match Day is on a Friday!)
Here are my top tips for students in the final days of creating their match list:
1. Think twice before leaving off a program that you interviewed at. Before leaving off a program, consider whether you would rather enter the scramble (aka SOAP) or go to the program. The length of the rank list is the strongest predictor of matching. This means you should not “suicide” match – or just list 1 place due to false assumption that you are definitely ‘promised a spot’ there.
2. Consider where you want to live and other non-program factors when constructing your list. When faced with programs that look very similar, think of locations that you would be happy. Many people settle in the city that they do their residency training in. It may be especially difficult to distinguish between programs the further you go down your list – so definitely consider location at that point.
3. Don’t worry about where the program ranks you. Remember – the match algorithm works in your favor – so its to your benefit to rank programs in the order you want to go to them and not try to ‘guess’ where they will rank you or reorder your list.
4. Avoid 11th hour changes. These will likely be motivated by faulty reasoning. Instead, talk over your decisions with your friends and family well before so you can relax
5. Don’t forget to press “certify”! The last thing you want to do is be undone by failure to press this button before February 22nd at 8pm Chicago time.
A video of some of good rank list tips here by Dr. Reddy:
I should also add that because everyone’s case is different, its important to consult with a faculty member who is knowledgeable about the field and advising you on the process. Good luck! I’ll be rooting for you on Match Day.