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ace_inhibitor111 said:
Make it so there is one date that applicants have to choose a single acceptance, although they are able to lock-in earlier if they want, similar to medical school admissions. If they enforced a similar process it would be better than the match.
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See you say that, but a) that doesn't make it true and b) I don't think it would be.
 
ace_inhibitor111 said:
Make it so there is one date that applicants have to choose a single acceptance, although they are able to lock-in earlier if they want, similar to medical school admissions. If they enforced a similar process it would be better than the match.
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The problem with this is that every time a person is holding onto 2 offers before the deadline, someone else will have no offers. Programs can't offer more spots than they are approved for, unlike medical schools which commonly offer more spots than the have knowing that some people will turn them down. That's because schools can flex up if more people accept than they expected. Programs cannot. We have an exact number of trainees -- we can't have any more, nor any less. So this would work well for some people who get more than one offer, but lots of people would get nothing.

And then what happens if you get an offer and accept it by the deadline, and then after the deadline a program you like more now has an opening? Either you need to let people switch programs (which then causes a ripple effect as more people get more offers) or you need to say that once someone "locks in" they cannot receive further offers (which will result in some people getting "worse" spots).

This is exactly what the match is designed to address. You can't be hurt in the match by ranking your reach position #1.
 
If the idea is to "guarantee" people a spot earlier in the process to avoid some of the churn, it might be possible to do something like this with a floating window. Programs can offer a position to an applicant at any time. Applicants have 48-72 hours to decide whether to accept. Once accepted, you can continue to get new offers. Every time you get a new offer, you have 72 hours to either keep what you already have, or switch to one of your new offers. That way, programs will know in a timely fashion when you've released an offer, and can offer the spot to someone new.

This solution would give many applicants an earlier answer. But it creates huge new problems: Programs would now have new logic to whom they want to offer spots to -- it might increase the practice of "yield protection", offering spots to weaker candidates earlier so they lock in. Couples would be a new mess, since they wouldn't be able to link the timing of offers. Trying to create a uniform offer date creates all of the problems above -- a small number of people will get all the offers, leaving lots of people with none. I don't think this is better than the current state.
 
ace_inhibitor111 said:
Make it so there is one date that applicants have to choose a single acceptance, although they are able to lock-in earlier if they want, similar to medical school admissions. If they enforced a similar process it would be better than the match.
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It wouldn't work particularly well, since everything would be put off to the last minute. The only way to do such a thing would be to have like, 5+ dates on which candidates have to decide on a program, or hold off and relinquish the ones they have been offered in the hopes of a better offer the next round. Such a system would basically be the worst of the match and the old system combined
 
NotAProgDirector said:
If the idea is to "guarantee" people a spot earlier in the process to avoid some of the churn, it might be possible to do something like this with a floating window. Programs can offer a position to an applicant at any time. Applicants have 48-72 hours to decide whether to accept. Once accepted, you can continue to get new offers. Every time you get a new offer, you have 72 hours to either keep what you already have, or switch to one of your new offers. That way, programs will know in a timely fashion when you've released an offer, and can offer the spot to someone new.

This solution would give many applicants an earlier answer. But it creates huge new problems: Programs would now have new logic to whom they want to offer spots to -- it might increase the practice of "yield protection", offering spots to weaker candidates earlier so they lock in. Couples would be a new mess, since they wouldn't be able to link the timing of offers. Trying to create a uniform offer date creates all of the problems above -- a small number of people will get all the offers, leaving lots of people with none. I don't think this is better than the current state.
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This is kind of like the system that existed before the match. It resulted in stronger programs taking their time, because they knew applicants would likely immediately accept their offers, while weak programs would immediately throw offers at everyone that was way out of their league in the hopes that they would want to just get the process over with and accept their offer since they wouldn't know if a better one would ever come around. It was particlarly bad for competitive specialties- if you get a call from a lower-ranked ortho program day 1, you know if you turn it down you can't take that back. And it's a competitive specialty, so you may never get another call once you turn it down.

People like the idea of doing away with the Match because they feel like they would have more control, however the match was devised precisely because applicants and programs felt powerless in the system that existed before. It was much more gameified and much less kind. In the Match, things are applicant-driven, and applicants end up with the best possible result. They have far more control than a free-for-all system would ever afford them. Anyone who thinks they are better off without the Match is either a fool, bitter, or doesn't understand the underlying mathematics.
 
OP, it works both ways. I matched my top choice and over time, after seeing the true character of the leadership, I realize I made a terrible choice. At least your program still has the potential to turn out well.
 
7331poas said:
The fact that they specifically addressed the match as an exemption from anti-trust law implies that it is inherently anti-trust.
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If you actually read the law they go quite in-depth about why it is in the best interest of the public and the participants that this particular exception exist. Antitrust law is meant to serve the greater good, and in this case the greater good was determined to be that the Match not be considered to violate antitrust law.
 
How about if people had more than an hour to come up with their SOAP app? And why can't match day happen earlier? Like, really soon after rank lists are finalized.
 
Mad Jack said:
If you actually read the law they go quite in-depth about why it is in the best interest of the public and the participants that this particular exception exist. Antitrust law is meant to serve the greater good, and in this case the greater good was determined to be that the Match not be considered to violate antitrust law.
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What % of the waiver do you think should be attributed to it actually being the for the greater good vs. because hospital systems can take advantage of residents by paying them far less of what they are actually worth?
 
jambro said:
What % of the waiver do you think should be attributed to it actually being the for the greater good vs. because hospital systems can take advantage of residents by paying them far less of what they are actually worth?
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95%. There is a chance hospitals would actually be able to pay residents *significantly less* without an even playing field. Since it is technically a training program, if it were a free for all they could do as dental fellowships do and *charge you tuition* while pocketing the medicare money.
 
Mad Jack said:
95%. There is a chance hospitals would actually be able to pay residents *significantly less* without an even playing field. Since it is technically a training program, if it were a free for all they could do as dental fellowships do and *charge you tuition* while pocketing the medicare money.
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This exactly. You think every derm and ortho program couldn't charge tuition and still fill?
 
jambro said:
How about if people had more than an hour to come up with their SOAP app? And why can't match day happen earlier? Like, really soon after rank lists are finalized.
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This. Give people a few weeks. Stop this nonsense of trying to hide who has to soap and what programs didn’t fill. Anyone who cares could find this out in a few minutes if they wanted to anyway.

If our holy algorithm is so sacred, let people just apply to programs, create a new ROL, and run it again.
 
Mad Jack said:
95%. There is a chance hospitals would actually be able to pay residents *significantly less* without an even playing field. Since it is technically a training program, if it were a free for all they could do as dental fellowships do and *charge you tuition* while pocketing the medicare money.
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They could do this right now couldn't they? It just so happens that all these residency programs haven't colluded together to do that right now.

I see your point, but any system that pays resident physicians less than many of the far less-educated employees in healthcare, with worse benefits and protections, just seems not ideal on its face. There has to be something better. Unions could be an answer.
 
jambro said:
They could do this right now couldn't they? It just so happens that all these residency programs haven't colluded together to do that right now.

I see your point, but any system that pays resident physicians less than many of the far less-educated employees in healthcare, with worse benefits and protections, just seems not ideal on its face. There has to be something better. Unions could be an answer.
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They can't do this because of standards that have been set with the consideration of the Match process by the ACGME. Without a match it could be argued that all applicants are independent agents and free to make their own choices, for good or ill
 
jambro said:
What % of the waiver do you think should be attributed to it actually being the for the greater good vs. because hospital systems can take advantage of residents by paying them far less of what they are actually worth?
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You do know that dentists pay for their residencies, right?

I want to encourage the OP to get a good attitude and try and see the silver lining.
My medical school has the tradition of opening a letter with your spot in front of the entire class (a good chunk of whom are sloshed). I got into my next to last spot. (3rd of 4 to be exact). I wasn’t a good medical student . . . So I get to open a letter in front of my friends and learn i get to spend the next 3 years in a place I really didn’t want to go.

I’m really glad, looking back, on how things turned out. I got good training. I was really one of the better residents in my batch. Sure, it was kinda in BFE. Now, 6 years after residency. . . Life is good.
 
jambro said:
How about if people had more than an hour to come up with their SOAP app? And why can't match day happen earlier? Like, really soon after rank lists are finalized.
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Or at least those who don’t match to find out on Friday, so they have the weekend to absorb the shock, seek advice, and make a list of programs etc...instead of 4 hours. That is just brutal.
 
frenchyn said:
Or at least those who don’t match to find out on Friday, so they have the weekend to absorb the shock, seek advice, and make a list of programs etc...instead of 4 hours. That is just brutal.
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I'm sure SOAP could be improved, but you have to bear in mind that it's a) still pretty new and b) 100X better than the previous system.

I'd be surprised if it's not being looked at regularly to see how it could be made better.
 
Mad Jack said:
If you actually read the law they go quite in-depth about why it is in the best interest of the public and the participants that this particular exception exist. Antitrust law is meant to serve the greater good, and in this case the greater good was determined to be that the Match not be considered to violate antitrust law.
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The U.S. Congress specifically exempted the match from the antitrust law in 2004. As a result the lawsuit brought to challenge the match on antitrust grounds was dismissed. One of the principal sponsors of the antitrust exemption was Senator Edward Kennedy.
Jung v. Association of American Medical Colleges - Wikipedia
Here's a link to the text of the statute providing the exemption:
15 U.S.C. § 37b - U.S. Code Title 15. Commerce and Trade § 37b | FindLaw
You will note that 15 U.S.C. 37b specifically provides that residency programs may not collude with each other to fix the salaries and benefits of residents.
 
VA Hopeful Dr said:
I'm sure SOAP could be improved, but you have to bear in mind that it's a) still pretty new and b) 100X better than the previous system.

I'd be surprised if it's not being looked at regularly to see how it could be made better.
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The NBME is always looking at everything. About the only reason I want to attend the AAMC annual meeting this year is to hear the annual ERAS/NBME update session. Should be quite interesting.

One of the inherent problems is that students who are at high risk of SOAPing are fairly easy to identify, but only about half of them actually accept it and come up with a plan (new personal statement and rec letters) in advance. The other half wander in on Monday morning stunned that what we had been telling them for months turned out to be valid.
 
Medical students’ hatred of the match reminds me of the time I played golf with a fellow who had graduated from Harvard Law School in 1974. He was at HLS when the movie “Paper Chase” was filmed. That film is about the experience of a first year law student at Harvard and I highly recommend it. There was a character in the movie who supposedly had perfect recall but was unable to derive the legal principles demonstrated in legal opinions. I told my fellow golfer that this character was completely unrealistic because anybody who could gain acceptance at HLS could read cases and derive the key lessons from cases.

My golf partner from Harvard agreed with me but said that some students at Harvard Law School were miserable because they weren’t the smartest person in the room anymore. Since the first year of high school they were smarter than their classmates, teachers and friends but that wasn’t the case when they got to Harvard. When they got the needle from professors and wise guy classmates, they turtled.
The Paper Chase skulls full of mush - YouTube

Graduating medical students were typically high school valedictorians and graduated at least cum laude from college. When medical students end up at their fourth residency choice they realize that residency programs in fields like internal medicine, emergency medicine and pediatrics may have cumulatively ranked them below 75 other applicants. That hurts. It’s humiliating. To many it’s inexplicable. This generates rage against the NRMP machine.

The 5 cent psychiatrist’s office is now closed for the day.
 
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Med Ed said:
One of the inherent problems is that students who are at high risk of SOAPing are fairly easy to identify, but only about half of them actually accept it and come up with a plan (new personal statement and rec letters) in advance. The other half wander in on Monday morning stunned that what we had been telling them for months turned out to be valid.
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SO true at my school. These students are extraordinarily resistant to good advice!
 
Obnoxious Dad said:
Medical students’ hatred of the match reminds me of the time I played golf with a fellow who had graduated from Harvard Law School in 1974. He was at HLS when the movie “Paper Chase” was filmed. That film is about the experience of a first year law student at Harvard and I highly recommend it. There was a character in the movie who supposedly had perfect recall but was unable to derive the legal principles demonstrated in legal opinions. I told my fellow golfer that this character was completely unrealistic because anybody who could gain acceptance at HLS could read cases and derive the key lessons from cases.

My golf partner from Harvard agreed with me but said that some students at Harvard Law School were miserable because they weren’t the smartest person in the room anymore. Since the first year of high school they were smarter than their classmates, teachers and friends but that wasn’t the case when they got to Harvard. When they got the needle from professors and wise guy classmates, they turtled.
The Paper Chase skulls full of mush - YouTube

Graduating medical students were typically high school valedictorians and graduated at least cum laude from college. When medical students end up at their fourth residency choice they realize that residency programs in fields like internal medicine, emergency medicine and pediatrics may have cumulatively ranked them below 75 other applicants. That hurts. It’s humiliating. To many it’s inexplicable. This generates rage against the NRMP machine.

The 5 cent psychiatrist’s office is now closed for the day.
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It still baffles me that people get traumatized by the realization they're not the smartest. I'm not sure if it's arrogance or what but being surrounded by smart and talented people can justifiably lead to valid imposter syndrome feelings but that should be motivating to improve and become better. Not a crashing reality check.
 
Lawpy said:
It still baffles me that people get traumatized by the realization they're not the smartest. I'm not sure if it's arrogance or what but being surrounded by smart and talented people can justifiably lead to valid imposter syndrome feelings but that should be motivating to improve and become better. Not a crashing reality check.
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It doesn't baffle me at all because I was one of those people, through and through. You don't learn to appreciate the true value of other people and that you may not be better than them until you have failed, and often time failed very seriously and more than once.

Medical students in general have never failed seriously in their lives yet or had actual objective hardship. And honestly, objective hardship still doesn't mean you failed - quite the opposite, you may have succeeded in spite of even higher obstacles and it makes the problem worse. Again, this was sort of me. There are certainly people who hard harder upbringings and obstacles than me, but I did not have a prim rose path to and through medicine and still had a god complex until I failed, badly. Then I learned.
 
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