All-in or prematch, is it on institution or program level?

[IMvrach]

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I am IMG and I got IV invites in IM from UPMC international scholar track and from SIUH. Both conduct IVs in September and October only. My explanation to no late IVs was they are going for prematch. But I thought prematches are over... Today I got an IV invite from St Barnabas and they write to ask about "early decision" program at IV. Curious, I went to their site and found:

http://www.barnabashealth.org/education/sbmc/intmed/index.html
"PLEASE NOTE THAT FOR THE RESIDENCY CLASS ENTERING IN 2013 OUR PROGRAM WILL NOT BE PARTICIPATING IN THE NRMP'S MATCH PROGRAM. ALL OFFERS FOR POSITIONS IN THE RESIDENCY PROGRAM WILL BE MADE OUTSIDE OF THE MATCH SYSTEM. "

...and the prematches are alive. But should not "all-in" policy be institution wide? But, say, anesthesiology at St Barnabas does not give a hint about the prematches. And I would be surprised if UPMC is going prematch only hospital-wide...

So, the question is: may an institution offer prematches for only some programs and not other?

 

[gutonc]

I don't have an answer to your question. But this answers the question that many of us had about the crappy NE IMG mills and how they'd handle the "all in" rule. They're opting out.

 

[IMvrach]

Ok, it seems individual programs can withdraw from the match under conditions they don't admit US seniors. Not a huge change for the programs that did mostly prematch. Pitty the prematches were not banned at all...


http://www.nrmp.org/res_match/policies/map_institution.html#pro_exclusive
4.2 Exclusive Commitment to the Main Residency Match

The sponsoring institution agrees that prior to the release of the results of the Main Residency Match, all of the programs sponsored by the institution, including those that do not participate in The Match, will select senior students of US allopathic medical schools only through the Main Residency Match or another national matching plan. If any position is offered to US allopathic students outside the Main Residency Match or another national matching plan, including a preliminary position for a program that participates in another national matching plan, the institution and the program will be in breach of this Agreement and may suffer the penalties described in Section 10.0.

In addition, the sponsoring institution agrees that all of the programs sponsored by the institution that participate in the Main Residency Match shall register and attempt to fill all of their positions through the Main Residency Match. The NRMP shall regularly monitor the compliance of Match-participating programs in registering and attempting to fill all of their positions through The Match. Failure to comply shall be considered a breach of this Agreement and the institution or program may suffer the penalties described in Section 10.0.

 

[Law2Doc]

Ok, it seems individual programs can withdraw from the match under conditions they don't admit US seniors. Not a huge change for the programs that did mostly prematch. Pitty the prematches were not banned at all...


http://www.nrmp.org/res_match/policies/map_institution.html#pro_exclusive
4.2 Exclusive Commitment to the Main Residency Match

The sponsoring institution agrees that prior to the release of the results of the Main Residency Match, all of the programs sponsored by the institution, including those that do not participate in The Match, will select senior students of US allopathic medical schools only through the Main Residency Match or another national matching plan. If any position is offered to US allopathic students outside the Main Residency Match or another national matching plan, including a preliminary position for a program that participates in another national matching plan, the institution and the program will be in breach of this Agreement and may suffer the penalties described in Section 10.0.

In addition, the sponsoring institution agrees that all of the programs sponsored by the institution that participate in the Main Residency Match shall register and attempt to fill all of their positions through the Main Residency Match. The NRMP shall regularly monitor the compliance of Match-participating programs in registering and attempting to fill all of their positions through The Match. Failure to comply shall be considered a breach of this Agreement and the institution or program may suffer the penalties described in Section 10.0.

Actually a LOT of the small community programs used to do both prematch and the match (basically cherry picking the best of the IMG crowd ahead of time before filling the remaining spots in the match and scramble). So the rule basically forces to choose one or the other. I'd bet the change still cuts the number of pre matches available in half or less. Not that many places I've seen totally filled with pre matches, they just used it to lock up a few of the better then average folks early.

 

[zappeuse]

wow, thanks for the interesting post. my question: programs that DO NOT participate in NRMP, fill their positions only by prematches?

 

[Law2Doc]

wow, thanks for the interesting post. my question: programs that DO NOT participate in NRMP, fill their positions only by prematches?

They have to, that's what we are saying. If they (or any program at that institution) participate in the match they can't do pre matches, and if they do pre matches they can't be part if the match. That's the concept of all in.

 

[repsbrah]

thanks for bringing this up, so essentially the prematch system will be alive and well. it seems that only the US Senior students would be at a disadvantage?

 

[IMvrach]

It's more. In addition, US seniors are barred from prematches altogether IF some other program participates in the match.

If you look at the quote from the NRMP contract I posted above, if I read it correctly, NRMP expects all programs to try in good faith to fill all positions in the match. As St. Barnabas states explicitly on their IM web page they fill everything by prematch, they are either in breach of contract or they are going to fill all other programs, not just IM, by prematch.

The program can decide anytime till Feb. 1 whether they participate in the match, meaning you can apply there, even interview and in the end find they withdraw. Precisely what happened with St. Barnabas. When I paid my $25 they were in the match:

Cached
http://webcache.googleusercontent.com/search?q=cache:vbaSAlTFzGQJ:http://www.barnabashealth.org/education/sbmc/intmed/index.html%2Bst+barnabas+internal+medicine+residency+program&hl=en&client=safari&tbo=d&nota=1&biw=768&bih=928&ct=clnk

vs now:

http://www.barnabashealth.org/education/sbmc/intmed/index.html

They have to, that's what we are saying. If they (or any program at that institution) participate in the match they can't do pre matches, and if they do pre matches they can't be part if the match. That's the concept of all in.

 

[IMvrach]

It seems US seniors will just lose time and money applying to such places.

thanks for bringing this up, so essentially the prematch system will be alive and well. it seems that only the US Senior students would be at a disadvantage?

 

[IMvrach]

.

 

[zappeuse]

It's more. In addition, US seniors are barred from prematches altogether IF some other program participates in the match.

If you look at the quote from the NRMP contract I posted above, if I read it correctly, NRMP expects all programs to try in good faith to fill all positions in the match. As St. Barnabas states explicitly on their IM web page they fill everything by prematch, they are either in breach of contract or they are going to fill all other programs, not just IM, by prematch.

The program can decide anytime till Feb. 1 whether they participate in the match, meaning you can apply there, even interview and in the end find they withdraw. Precisely what happened with St. Barnabas. When I paid my $25 they were in the match:

Cached
http://webcache.googleusercontent.com/search?q=cache:vbaSAlTFzGQJ:http://www.barnabashealth.org/education/sbmc/intmed/index.html%2Bst+barnabas+internal+medicine+residency+program&hl=en&client=safari&tbo=d&nota=1&biw=768&bih=928&ct=clnk

vs now:

http://www.barnabashealth.org/education/sbmc/intmed/index.html

does it mean that until February 1st they can also choose to participate in the Match?..

 

[gutonc]

It's more. In addition, US seniors are barred from prematches altogether IF some other program participates in the match.

US Seniors have always been prohibited from pre-matching.

 

[repsbrah]

does it mean that until February 1st they can also choose to participate in the Match?..

that is my understanding. they have until jan 31st to opt in or opt out of the match.

is it unreasonable to ask the program @ the time of interview whether they have decided they are participating in NRMP or not?

 

[IMvrach]

Yes, but a US senior could apply to, say St. Barnabas, as a safety and participate in the match. Now St. Barnabas is closed for them shut. So those who applied there wasted their money.

US Seniors have always been prohibited from pre-matching.

 

[gutonc]

Yes, but a US senior could apply to, say St. Barnabas, as a safety and participate in the match. Now St. Barnabas is closed for them shut. So those who applied there wasted their money.

I can assure you that there aren't that many US seniors who would apply to St. Barnabas, or SIUH or any of the other programs that will be going this route.

 

[Law2Doc]

Yes, but a US senior could apply to, say St. Barnabas, as a safety and participate in the match. Now St. Barnabas is closed for them shut. So those who applied there wasted their money.

True, but the number of programs with pre matches has dramatically decreased, because any institution with any progrm that wants to be in the match will force that program to forego prematching. Basically means more of the spots out there are now in the match, and the US grads now get first crack. It's a big net hit on the nonUS crowd because there are now fewer pre matches and they are now concentrated at fewer community hospitals. The IMGs who previously would be cherry picked before the match just lost a lot of options.

 

[IMvrach]

I don't see it a loss by any stretch. IMGs who were offered prematch by a program are likely to be highly ranked by them now and match. I don't see any advantage to the prematch but stress reduction. A huge advantage is that with all-in an IMG can remain hopeful to match in a competitive program without losing his safety programs net by declining prematches there.

True, but the number of programs with pre matches has dramatically decreased, because any institution with any progrm that wants to be in the match will force that program to forego prematching. Basically means more of the spots out there are now in the match, and the US grads now get first crack. It's a big net hit on the nonUS crowd because there are now fewer pre matches and they are now concentrated at fewer community hospitals. The IMGs who previously would be cherry picked before the match just lost a lot of options.

 

[quique2]

As another IMG myself, the way I see it is that most programs will end up ranking most US seniors above IMGs anyway. It would be hard to justify placing anything but the most competitive of IMGs above a typical US senior on a ROL. Not to say that a solid IMG applicant couldn't match somewhere decent, but like Law2Doc says, US seniors will continue to get first crack at spots (arguably as it should be).

 

[Law2Doc]

I don't see it a loss by any stretch. IMGs who were offered prematch by a program are likely to be highly ranked by them now and match. I don't see any advantage to the prematch but stress reduction. A huge advantage is that with all-in an IMG can remain hopeful to match in a competitive program without losing his safety programs net by declining prematches there.

See quique's post above. By entering the match, all IMGs pretty much end up taking spots left over by US grads. That wasn't always the case with pre matches, where both programs and applicants were willing to forego the uncertainty of the match to lock up a sure thing, which in many cases for the IMG worked out better because he was never compared head to head with US grads. It's one thing for a program to say "this guy is probably as good as we are going to get" and lock him up in a prematch, versus actually just ranking people and finding out for real who is as good as they are going to get.

 

[jackets5]

But a lot of the places that per-matched people I know we're never places that US grads really even apply to. So for something like IM where pretty much all US grads get spots to begin with, not sure the actual affect. What I do know from friends and people I rotated with needing a visa is becoming a bigger and bigger problem.

 

[Law2Doc]

But a lot of the places that per-matched people I know we're never places that US grads really even apply to. So for something like IM where pretty much all US grads get spots to begin with, not sure the actual affect. What I do know from friends and people I rotated with needing a visa is becoming a bigger and bigger problem.

But as enrollment in US schools is increasing, more and more US grads are looking at places they hadn't in prior years. I think the point is that by increasing enrollment and eliminating pre matches, they are gradually squeezing the offshore crowd out of the game pretty systematically. Anyone who doesn't see this as a negative impact on non US allo grads is nuts.

 

[IMvrach]

Why nuts? Obviously increasing US enrolment will negatively impact IMGs, no argument here. But not the all-in policy. It's all game theory: prematches at a program will likely match there. Recall that 92% manage to finish their visa paperwork in time so there is no real advantage for a program to offer a prematch versus ranking candidate high.

Moreover, low competitive programs, such as NY Methodist and St. Barnabas, went pre-match entirely and IMGs no longer face competition there from AMGs. And those who accept prematches at St Barnabas were particularly vulnerable to be left unmatched.

But as enrollment in US schools is increasing, more and more US grads are looking at places they hadn't in prior years. I think the point is that by increasing enrollment and eliminating pre matches, they are gradually squeezing the offshore crowd out of the game pretty systematically. Anyone who doesn't see this as a negative impact on non US allo grads is nuts.

 

[Law2Doc]

Why nuts? Obviously increasing US enrolment will negatively impact IMGs, no argument here. But not the all-in policy. It's all game theory: prematches at a program will likely match there. Recall that 92% manage to finish their visa paperwork in time so there is no real advantage for a program to offer a prematch versus ranking candidate high.

Moreover, low competitive programs, such as NY Methodist and St. Barnabas, went pre-match entirely and IMGs no longer face competition there from AMGs. And those who accept prematches at St Barnabas were particularly vulnerable to be left unmatched.

Again, pre matches happen because the program is willing to cherry pick a qualified IMG to avoid the uncertainty of the match, and a lot of time spent interviewing. In other words, they are typically willing to lower their standards a bit to eliminate a component of risk. It's not so likely that same IMG would rise to the top of their rank list though, since they are really pulling the trigger before seeing who is out there.

Look at it sort of like going to a singles bar and hooking up right away with a person you aren't particularly attracted to, but not hideous, rather than risking a night of rejection from people you are more attracted to. You'll never know who you could have had, but at least you didn't go home alone or get stuck with a less desirable straggler at the end, and you saved yourself an evening of buying drinks.

As mentioned, sure there are one or two programs that are going exclusively the prematch route, but the number of places that used to do pre matches and now don't far far outnumbers these slots -- it's a big net loss. For instance I know of 5 community hospitals who used to offer pre matches in IM and now none can because they each have other programs that are in the match. So for every St Barnabas that increases their prematch spots, there are probably 5-10 community hospitals that are closing their doors to pre matches. Its not complicated math -- That's a big big hit for the IMG crowd. you are basically now forced to go head to head with the hotter guys/gals in the singles bar -- no more hooking up early. And with the cream of the IMG crops grabbing those few prematch spots you mentioned, there will be an even bigger discrepancy in quality between the US and IMG folks in the match, leaving more IMGs frustrated.

 

[IMvrach]

Ok, I can see the point of saving effort interviewing more candidates - effort that could uncover candidates more competitive than an IMG who could be offered a prematch.

But just to make it clear, personally, I hate prematches and I'm a bad advocate for them. While I feel I'm a rather competitive candidate, I still must apply broadly due to unpredictability of attitude to IMGs, not perfect English etc. And out 6 IVs I got by now, 3 will go prematch, meaning loss of application fees for me. I see it as if without warning the match were split into two incompatible matches and I must decide in which of them to participate.

So I wrote to NRMP regarding this and here is the response:

The All In Policy is program-based, meaning that programs can decide individually whether they wish to participate in the Main Residency Match. If the All In Policy was institution-based, the decision to participate in the Main Residency Match would apply to all programs at said institution. That is not currently how the All In Policy works.

You are free to interview with ... for a non-Match position. If you have registered for the Main Residency Match you must withdraw from the Match prior to the rank order list deadline if you accept a non-Match position.

Regards,
Laurie S. Curtin, Ph.D., Director Match Policy
National Resident Matching Program

For instance I know of 5 community hospitals who used to offer pre matches in IM and now none can because they each have other programs that are in the match.

 

[thesauce]

Again, pre matches happen because the program is willing to cherry pick a qualified IMG to avoid the uncertainty of the match, and a lot of time spent interviewing. In other words, they are typically willing to lower their standards a bit to eliminate a component of risk. It's not so likely that same IMG would rise to the top of their rank list though, since they are really pulling the trigger before seeing who is out there.

Look at it sort of like going to a singles bar and hooking up right away with a person you aren't particularly attracted to, but not hideous, rather than risking a night of rejection from people you are more attracted to. You'll never know who you could have had, but at least you didn't go home alone or get stuck with a less desirable straggler at the end, and you saved yourself an evening of buying drinks.

As mentioned, sure there are one or two programs that are going exclusively the prematch route, but the number of places that used to do pre matches and now don't far far outnumbers these slots -- it's a big net loss. For instance I know of 5 community hospitals who used to offer pre matches in IM and now none can because they each have other programs that are in the match. So for every St Barnabas that increases their prematch spots, there are probably 5-10 community hospitals that are closing their doors to pre matches. Its not complicated math -- That's a big big hit for the IMG crowd. you are basically now forced to go head to head with the hotter guys/gals in the singles bar -- no more hooking up early. And with the cream of the IMG crops grabbing those few prematch spots you mentioned, there will be an even bigger discrepancy in quality between the US and IMG folks in the match, leaving more IMGs frustrated.

I haven't enjoyed an SDN post this much for quite a while