aProgDirector mentioned something about ideas for changing the match system in a post in a previous thread. I thought instead of hijacking, I would start a new thread.

I think the overall concept of the match is "the worst system except for all the alternatives," so I am not going to take issue with the basic design. So, I'll bite on reform.

I heard rumblings about maybe some changes to the process on the interview trail, so I will make some suggestions from a student's perspective. Obviously, I have no idea about the bureaucratic feasibility of any of this stuff.

1.) Reform of the interview invitation process.

Regulate and centralize (e.g. make it a web-based system like ERAS or the NRMP) WHEN and HOW students receive and schedule interviews. After having just gone through a couples' interview season, I learned that interviews would trickle in from programs in a completely idiosyncratic fashion and occur on seemingly random dates (e.g. some programs only Tuesdays, others only Fridays, etc), creating a travel logistics nightmare. Some programs that were in the same general geographic location seemed to intentionally offer their interviews on the same dates as "rival" programs (more a problem in the surgical subspecialties), thereby making it impossible to visit both programs in one trip. I know several people who were forced to make multiple cross-country flights. I really don't think programs understand how much time and money it takes to travel around and how much easier it would be to be able to schedule programs in a geographically logical process.

It would make scheduling much, much easier to receive all the interviews on one mandated date through a centralized system. Then, you could have a second deadline for students to schedule the interviews.
By centralizing the process, you could prevent people from being crazy and limit the number of total interviews accept by preventing people from "double-booking" by scheduling interviews at programs they have little intention of attending for "safety" (because some of the more competitive programs seem to offer interviews at later dates). I am guilty of this myself, as I was advised to schedule more interviews than I needed with the idea that I could always cancel them later. Programs would benefit because they would have a firm idea of who was coming and could make adjustments accordingly.

After the initial scheduling of interviews, a third date could come around with the interview slots that were still open and programs could offer interviews to students in order to fill their interview slots (a "mini-scramble" or something), again via a centralized process. This would save everyone, including the administrative staff at programs, a lot of time and effort and bring order to a pretty chaotic process.

2.) Shrink the time from the submission of rank-order lists to match day.

Correct me if I am wrong, but I met a pediatric neurology person who said that they submit their rank lists and match a week later. Why can't all specialties be like this? I don't think the computer algorithm needs that much time to figure everything out.....

3.) Push the interview season later.

This might be controversial, but by shrinking the time between rank order lists and match day, you could push the interview season further into the calendar. Maybe Feb/March/April or March/April/May. I know that administrators at my institution hate how most of fourth year is essentially wasted by students who just "take time off" after their transcript is in. I think that by pushing interview season later, it would open up more time for electives, away rotations, etc., and give programs a wider body of clinical evaluations to judge prospective residents. Furthermore, by cold-weather programs might benefit by not having applicants come in the middle of December/January, when the weather is worst. It would also make travel safer; after a white-knuckle drive from the mid-west in late december in a blizzard, I got stuck for 24 hours in a Denny's outside Buffalo because they closed all of the highways. Not fun.

Just some thoughts.

Maybe the NRMP can borrow a few supercomputers for their matching process.
That would probably speed things up.

http://moviesmedia.ign.com/movies/image/article/745/745946/top-10-bond-deaths-20061114034914884-000.jpg

It would make scheduling much, much easier to receive all the interviews on one mandated date through a centralized system. This would be amazing. At present, some programs have a convenient computerized scheduling system - no waiting for confirmations, not limited to work hours since we are working those same hours, too. I would prefer that all programs do something like this, and preferably on the same day so we can plan ahead.


Shrink the time from the submission of rank-order lists to match day.
Agree - the wait is agonizing! More unsettling than the interval for step scores to come back.

By shrinking the time between rank order lists and match day, you could push the interview season further into the calendar. Maybe Feb/March/April or March/April/May. Disagree - way too late. We need time to move, adjust, settle in our new homes, and if orientation begins as early as mid-June, that is not enough time. In contrast, I think that interviews should begin after our applications go out in September. Unfortunately, this could be too early for students who are undecided about what field to pursue.

automatically give us our number one choices.

I think this match system is complete BS and a waste of money.

Graduate students all over the world find jobs just fine at great places without a retarded match ... and they don't spend a billion dollars to do it. Medical students choose a school without a match. I had to interview at 14 places when in all probability I actually only needed to interview at 1. Thanks NRMP for the $20k in debt.

The simple fact is that in all likelihood I will match at the same place I rotated and ranked #1 and I would have signed a contract with this summer except for the completely absurd match rules.

If something changes, there has to be a mechanism to extend prematch offers. It is moronic there is no mechanism to say "hey, I like you, you like me, lets get this done."

I suggest this:

#1. Programs can extend a prematch offer and may extend up to the number of spots they have to match. (ie if a program has 20 spots they can extend up to 20 pre-match offers)

#2. These prematch offers automatically fill the top of their rank order list.

#3. Students may either respond to the prematch offer or not, but the program cannot change the fact the students offered the prematch will be at the top of their list.

This gives the student the choice to quit interviewing and sign, or visit a few more programs.

Regulate and centralize (e.g. make it a web-based system like ERAS or the NRMP) WHEN and HOW students receive and schedule interviews.

I agree this might make things easier from the applicant standpoint, but is really hard to do from our standpoint.

1. You'd have to get all programs to agree to wait until after Dean's letters were out, since some programs wait for those. So, you'd all be biting your nails for that much longer.

2. If I only have 40 interview slots, I'd only be able to offer to 40 people, then wait to see who accepts, then offer more. Or, I could offer to 80 people and just make it first come first served. Either way, it's a nightmare on both sides -- option #1 the same 40 people get interviews from every program, and then only after they've chosen what interviews they want, would the next people get an invite, etc. So, it's possible that you'd get no invites on the official invite day, only to get invites 1-2 weeks later as people decline. That's really ugly. It's actually what happened in England last year (although they did it with offers for positions, not interviews), and was a complete nightmare.

3. This means that all 400 of the people I want to interview will call on the same day. That's going to be a nightmare for all.

4. This is almost a "match for interview slots".

5. This doesn't address the conflicts, or lack of coordination between geographically related programs. I'm not sure there's any way to deal with that. I certainly don't want some central group telling me which days I can interview on.

2.) Shrink the time from the submission of rank-order lists to match day.

Many have asked for this. The NRMP insists that the time is required to triple check the results, and get it right. They point to the AUA match disaster a couple of years ago, where match results were released and then proven incorrect, nullified, and run again.

3.) Push the interview season later.

As you cann see already, thoughts will be mixed about this one. PD's will stress that they need the match this early to get visas for IMG's, which is a time consuming process.

Graduate students all over the world find jobs just fine at great places without a retarded match ... and they don't spend a billion dollars to do it. Medical students choose a school without a match.

Both of these situations are inherently different. There are many more jobs than grad students, and the number of positions at each company is not regulated in any way. For med school, there are at least 10:1 applicants to spots, and medical schools have some flexibility in the number of students in the class -- if they plan a class size of 100, it really doesn;t matter if there are 90-110 students. This means that med schools can offer more "spots" than really exist, and if they're short at the start of the year can easily get a few more by offering to those who were not accepted.

I had to interview at 14 places when in all probability I actually only needed to interview at 1. Thanks NRMP for the $20k in debt.

This is only true if they would have offered you a spot early enough such that you were sure that you didn't need to interview elsewhere. For example, let's say they interviewed you on Nov 15th. If the rest of your interviews were in December, then you'd only feel safe canceling them if you already knew you had a spot. If that program told you on Jan 2nd that they were not taking you, and you hadn't interviewed elsewhere, you'd be screwed.

If something changes, there has to be a mechanism to extend prematch offers. It is moronic there is no mechanism to say "hey, I like you, you like me, lets get this done."

I suggest this:

#1. Programs can extend a prematch offer and may extend up to the number of spots they have to match. (ie if a program has 20 spots they can extend up to 20 pre-match offers)

#2. These prematch offers automatically fill the top of their rank order list.

#3. Students may either respond to the prematch offer or not, but the program cannot change the fact the students offered the prematch will be at the top of their list.

This gives the student the choice to quit interviewing and sign, or visit a few more programs.

This is an interesting idea. Again, it only helps if the offer comes in early enough so that you can cancel further interviews.

However, it creates a huge new problem / possibility for gaming the system. As a PD, I don't want to "waste" my prematch offers. I'll only want to use them for people who I feel are "guaranteed" to come. So, it will create more of this "let me know how badly you want to be here" stuff. Which will make people lie -- as it can't hurt you to keep interviewing once you have a guarantee, and applicants will try to obtain such guarantees even from their "safety" programs. It will make the competition for these guaranteed spots intense. For the vast majority of applicants (who will not get such guarantees), I think this will make things worse.

Ask people what it was like before the match and you'll hear some horrific stories that help explain quite clearly why the match process evolved into what it is today. It's not perfect, but then again, consider the alternative...students at top schools being pressured to sign contracts during their 2nd and 3rd years, before they're even sure of what they want to go into, recruited unfairly and aggressively, and perhaps unfairly over students at less prestigious schools, and forced to make premature decisions with far-reaching impact in their lives. Think about what it would be like to know what program you want to be at, but having an offer from another decent program elsewhere that expires in 48hrs, or maybe even twelve! Do you take a risk and hope for the top program, but risk losing a spot at either place, or do you just take the so-so spot and settle?

In many ways, the match system takes the power out of the hands of programs and puts it into the hands of the applicant. While you may not necessarily feel like you have the power as an applicant, you really do. The same goes for the fellowship match process. Gone are the days where interns are pressured to sign contracts before they've even had time to figure out for sure if a particular specialty is really what they want to do (still happens a bit, but not nearly as much now as more and more suespecialties have joined the match).

Here's a fascinating article with info about the history leading up to the creation of the Match process: http://kuznets.fas.harvard.edu/~aroth/jama.html

Sure, it's not perfect, and the process is expensive (like everything else in medical education in the U.S.), but we're in a MUCH better position than we would've been without the system.