Competition for residency slots

[Hopkins2010]

Forgive me, since I am completely ignorant on this issue, but I dont understand why some residencies are so tough to get into.

I hear about stuff like match rate and unfilled slots.. for example I thought I heard somewhere that one of the residencies has a 15% unmatched rate and thats indicative of a very tough residency to get into.

But doesnt that mean that 85% of all applicants to that residency matched somewhere? That seems very good considering the acceptance rate for med school is only about 40% or so. I realize that the people you are competing against for residencies are much more accomplished than for admission to MD programs, but still an 85% acceptance rate is very high.

Also, of what significance is the number of unfilled slots for a particular residency? Does that mean:

1) that nobody applied for those particular residencies

2) that the residency program received too few applicants so they just decided not to take anyone

3) that nobody in the applicant pool was qualified for the position?

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[GreatPumpkin]

A 15% US senior unmatched rate is a competitive residency. Yes that means 15% of the people did not match. But, these percentages don't tell the whole story. Many of the people that apply to these highly competitive programs put in back up choices at the end of their match list and end up matching in something else and therefore are not counted in these statistics. Also, in certain residencies there are so few spots that makes them even more competitive than the percentage shows.

As for the unmatched positions, it means that the computer match just didn't fill that spot. It could be for many reasons. It could be that not enough people ranked that program, I could be the program did not rank enough people. It could mean the specialty is not competitive and there are widespread unfilled positions. The match is complicated. But, lucky for us it is biased toward the applicant not toward the schools.

 

[ana]

An open slot can mean a couple of things:
1. It was never really open to begin with. That is, the program filled it outside of the match.

2. They didn't rank enough of the candidates they interviewed or not enough candidates ranked them highly enough.

15% is a very high unmatched rate. Many of these applicants may have to change to a whole other specialty or in a location that is undesireable for them. So you get whammied twice -- you have to do something else with the rest of your life and then you have to live it somewhere you may not have wanted to go to (at least for your residency). Think about it: you dreamed of being an orthopaedic surgeon, then you end up in primary care. Or you want to be an internist at a prestigious research university and you end up at a small community program. You wanted to be in Calif. with your family, you end up moving to New York.

There were a lot of happy people on my school's match day. But there were a few long faces and tears as well.

 

[Hopkins2010]

So I get the impression that this match process is a one shot deal?

That is, what if you don't get into a residency you prefer? Can you just enter the match again the next year and try again? Even if you could do that, is there almost a zero percent chance you would get in?

Or could you go ahead and enter the residency you matched to and then try again in a year to match again into a different one even though you are already in a program?

 

[Winged Scapula]

Originally posted by baylor21:
•So I get the impression that this match process is a one shot deal?

That is, what if you don't get into a residency you prefer? Can you just enter the match again the next year and try again? Even if you could do that, is there almost a zero percent chance you would get in?

Or could you go ahead and enter the residency you matched to and then try again in a year to match again into a different one even though you are already in a program?•

This has been a "HOT" topic over at Medschool.com, especially among some of the IMGs who seemingly ranked lots of places they didn't really want to be at, especially when the Unfilled Program List came out.

When you enroll in the match you sign a "binding" contract requiring you to accept a position if offered to you - ie., if you match. It is considered a violation of the legal contract and unethical to refuse to take the spot and accept another. This is why students are told not to rank a program that they would not want to be at - there is always a chance you could end up there (even if its at the bottom of your list).

The NRMP states that if you do not accept the position offered to you, you are unable to accept another position until the following year. How far and wide they pursue you for doing this is up for debate. Everyone seems to know someone who dumped the program he matched at and got another, more prestigious spot. I suppose if the first program were able to fill the spot with someone else they might not follow-up on you and/or "report" you to your new PD. I've been meaning to ask my new Residency Coordinator whether or not they tell the NRMP if the matched students actually sign. I do not know what your chances are to get a position in subsequent matches, although I suppose if word got around that you were a "deal breaker" it might be a bit rough.

If you did go ahead and start with the program you matched into, you could reenroll in the match for the following year. This requires a few things:
1) "approval" from your current PD
2) a PGY2 spot to open up
3) a PGY1 spot to open up if you were switching fields and enough HCFA funding to pay you for the duration of the second residency chosen.

It seems like more trouble than its worth. Bottom line: don't rank a program you woulnd't want to go to just so that you match.

 

[Amadeus]

For an applicant to dump their original match both parties (ie you and your PD) must agree to be released from the contract. Correct me if I'm wrong, but the PD can refuse to release you from the contract and you're left no choice but to go the program. Which in turn would leave you in a precarious position as the person who tried to bale on them. The take home message is that you don't rank a program you have no intentions of going to.

 

[Winged Scapula]

That is true - PDs must agree to release you from your contract. It is my understanding that they generally do, not wanting an uphappy resident with them - but how far they pursue this (ie, preventing student from accepting another position until the following year) is up for debate.

As Amadeus states, best tactic is to NOT rank any program you wouldn't be happy at.

 

[Firebird]

Ok...if a computer matches you to your residency, why do people sometimes interview for residency positions?

Briefly, how does this computer thing work?

 

[pcl]

Originally posted by Firebird:
•Ok...if a computer matches you to your residency, why do people sometimes interview for residency positions?

Briefly, how does this computer thing work?•

The algorithm is explained on the NRMP site.

Basically, it works this way:

The hospital recieves applications for it's open positions. These are then evaluated, and an initial selection is made, and those applicants are interviewed.

After interviews are complete, the hospital rank orders the applicants as to who they want in thier program.

Applicants also rank order the programs they would like to attend.

Say a hospital has 2 spots. They interview 5 applicants and rank them in order: A, B, C, D, & E

The computer than goes to the list and arbitrarily checks student C first, who has ranked the hospital first.

So the hospital has now "tentatively" matched Student C.

What can happen is that if A & B ranked the hospital highly, C can be bumped from that hospital and then the computer tries to re-match the student at their second choice. However, if A or B select a different hospital and secure a position there, student C gets to keep the residency spot.

So both the program & the student have to highly rank each other of a "match" to occur.

Hope that helps. You can get to the nrmp site through the AAMC site.

 

[Winged Scapula]

The URL is:
http://www.aamc.org/nrmp

Basically everyone interviews for position in the match; the exceptions would be people who accept positions outside of the match (ie, without going through the whole process). Thanks PCL for posting the details of the match algorithm.