Discarding the Match

[kugel]

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Perhaps it's time to discard the Match altogether.
With social media becoming so prevalent, maybe med students can press more effectively to dismantle the match once and for all, and be permitted to negotiate the best possible deal directly with residencies.

Med Students are competing for a JOB that happens to include lots of training.
Do graduates from Law School or a School of Education or Nursing School get TOLD by a computer where they will work for the first 3-5 years?

Let's consider what the world would be like if 4th year students simply applied for the job of resident and then went on job interviews. The job is an employment contract like any other job and you are welcome to negotiate the best possible deal you can make. Most institutions will set very narrow ranges for salary, but will provide different levels of training, access to leaders in the field, livability of the city, working conditions, etc.

Like with any other job, applicants want:
- high salary
- excellent training and prestige, so they will be highly sought for that next job
- good working conditions (colleagues/supervisors, amt of work, pleasant offices, etc.)
- good living conditions (lifestyle, recreation, education for kids, culture, weather, etc.)


Employers want:
- well-trained applicants
- good workers
- applicants who can get along with others and take supervision/feedback
- workers who will make the leadership look good

Residencies can make what ever offer they want to whatever applicant they choose, and the applicants are free to accept, reject, or defer those offers. Just like any other job.

This is one instance where I believe the market should work itself out.
Now if the government wants to increase the number of specialists in a geographic area, then it can throw additional subsidies at certain residencies to increase the salary, or make it easier to buy a home (a good way to increase the chances of the resident staying in that area), or other inducements. But those just become another factor in the market, which the applicant has to consider.

 

[JabsterL]

What an awesome, well-written post..thank you Kugel for your brilliant argument! Can anyone shed light on how/why the Match came to be in the first place, instead of just going with market forces like every other job (and school for that matter) application process??

 

[atsai3]

Perhaps it's time to discard the Match altogether.
With social media becoming so prevalent, maybe med students can press more effectively to dismantle the match once and for all, and be permitted to negotiate the best possible deal directly with residencies.

Med Students are competing for a JOB that happens to include lots of training.
Do graduates from Law School or a School of Education or Nursing School get TOLD by a computer where they will work for the first 3-5 years?

Let's consider what the world would be like if 4th year students simply applied for the job of resident and then went on job interviews. The job is an employment contract like any other job and you are welcome to negotiate the best possible deal you can make. Most institutions will set very narrow ranges for salary, but will provide different levels of training, access to leaders in the field, livability of the city, working conditions, etc.

Like with any other job, applicants want:
- high salary
- excellent training and prestige, so they will be highly sought for that next job
- good working conditions (colleagues/supervisors, amt of work, pleasant offices, etc.)
- good living conditions (lifestyle, recreation, education for kids, culture, weather, etc.)


Employers want:
- well-trained applicants
- good workers
- applicants who can get along with others and take supervision/feedback
- workers who will make the leadership look good

Residencies can make what ever offer they want to whatever applicant they choose, and the applicants are free to accept, reject, or defer those offers. Just like any other job.

This is one instance where I believe the market should work itself out.
Now if the government wants to increase the number of specialists in a geographic area, then it can throw additional subsidies at certain residencies to increase the salary, or make it easier to buy a home (a good way to increase the chances of the resident staying in that area), or other inducements. But those just become another factor in the market, which the applicant has to consider.

Most people would say that things were not necessarily better in the Golden Age (pre-Match) when the market was working itself out.

http://jama.ama-assn.org/content/289/7/909.abstract

I also think it is important to keep in mind that, as a medical student applying in the Match, you are "told" where you will be working within the set of residencies to which you applied. You are free to not apply to any programs that are located where you do not want to live.

 

[splik]

i agree with you about residency being a job. Med students forget this, even residents forget this, and I find it amusing the places that seem to see residency as training and not a job are the places that tend to be service heavy, with poor pay, vacation and benefits.

But there is a reason why we have the match, because a free for all doesn't work. In law or business only the most coveted applicants from the top schools have their pick, many others are left unemployed or in jobs with few prospects and an unimpressive salary. Further, they have the risk of being fired within months. Residency provides to some degree a much greater level of job security, and most peoople will be successful in securing a residency with good prospects after, but not necessarily what you want, where you want.

Education and Nursing are not the same. Medicine faces the same prospects as law and business - there are an increasing oversupply of applicants (including foreigners) which means that the market works in favor of the employer. Allowing this flourish will decrease salary, decrease benefits, and decrease overall satisfaction with the system for employees, except perhaps all but the most highly sought after. What is to stop prestigious places having an unpaid intern year knowing they might still be able to get excellent applicants doing so, knowing the cards are stacked in favor of them?

With nursing and education there are often not enough teachers (especially in math and science) and nurses. Having an open job system is more favorable to employees then.

The match isn't perfect, but it is mostly a fair system that allows applicants of varying strength the best shot of securing the most desired residency for them. If it were up to me, love letters would be banned (from either party) as well as calls/emails from PDs. I also think there should be minimum standards for salary (e.g. minimum of $60 000 for PGY-1 with minimum incremental salary of $3000 each year of training, large city cost-of-living weighting allowance, 4 weeks vacation, 1 week professional leave, 30 days paid sick leave, and $2000 educational stipend). Why Australia, Canada and the UK pay their residents more, have better benefits, and working conditions and generally treat them better has nothing to do with match/no match. These are the real issues, let's not pretend discarding the match will benefit medical students and residents. What we need is collective action to change things for the better.

 

[psychphan]

Lets not get crazy here. A computer doesn't tell us where to train. Many months of research into programs (which allowed me to apply to only places I considered a good fit), decisions of which interviews to accept, performance in those interviews (as well as performance in medical school, extracurriculars, board scores), and my personal rank list.... combined with my perceived desirability to programs, will determine where I train.

I think the match system is a good one, and actually works in favor of the applicant. It allows you access to experience a number of programs of your choice, and to really contemplate where you think you want to be, without being pressured by PDs and others to commit to programs early, and thus miss the opportunity to experience all the programs you wanted to (well I got an offer from program X, it was really towards the bottom of my list, but if I don't accept it, they may withdraw the offer and I get nothing! Better take it while I can and cancel my other interviews.)

I like the system, lets hope I'm still saying so on March 16th.

 

[Bartelby]

I actually like the match system. As has been mentioned above, it sounds like without the match the power difference between programs and applicants gets magnified. Programs could put the pressure on applicants to sign very early, they could violate their contracts with near impunity, they could make us undercut each other to provide terrible pay and working conditions, etc. I think in the end admissions would be much more 'politics' and less 'best person for the job.'

Also, let's not forget: if I don't take this 'job,' my other option is to have an MD, no license, no usable job skills, and six figures of debt. That doesn't leave me in a great bargaining position.

While the match system has some flaws, I think it is pretty solid. I have enjoyed the meritocratic nature of the interview and rank list process (despite the fact that some programs bend or break the rules) and would hate to have to get political to find a spot or sign with the first offer I received out of fear.

 

[Saluki]

In general, I like the idea of the match, but I am not sure I'll like the results... I think I made a few mistakes in my rank order list, and I didn't get any love notes from my top few programs...

I do wonder whether all the love letters, phone calls, etc. take away from the spirit of waiting for match day, but maybe that's just sour grapes talking....

 

[billypilgrim37]

This is a bad idea for the same reason that the pre-match is a bad idea. You trade all of your flexibility and ability to optimize for a guarantee that you will have a job. The information asymmetry is overwhelming, and none of it is in the applicant's favor. As it is now, you get to go to your favorite program that will have you based on their and other people's preferences. That's a pretty good deal.

Now, I can see there would be some sort of advantage to more open negotiations around salary and benefits, sure. And it would prevent rather shady things from happen, including this story, which I don't think I have told before on the forum, and have kept pretty quiet about otherwise:

My wife, who is now a law student, was taking post-bacc pre-med classes while I was in med school. She was planning on taking the MCAT the spring of my M4 year. I had one program (that I liked quite a bit anyway, but did not wind up ranking #1) attached to a top 10 medical school tell me that if I came there, they would guarantee me she would have a spot in the medical school, as several of the key faculty I knew were on the admissions committee (not just that they would advocate for her, that they would promise it). Granted, at that point, she had a 4.0 in her science classes, and is now at a top 10 law school, so she's probably pretty worthy, but she hadn't even taken the MCAT yet. Now, you could say there would be no way for me to necessarily hold them to it, but we both knew that if they didn't follow through on a promise like that that I would easily have the option to leave for child fellowship (and this was even intimated by them, as an assurance that they would follow through). To add to the shadiness, the offer was made while a faculty was driving me from one hospital to the next gratuitously (i.e., this wasn't the standard procedure). And it was all in the context of "we had a meeting the other day, and we decided to make you this offer."

This entirely turned my wife off. She didn't want any favors like that, and the idea of riding my coattails was some part of why she eventually decided not to apply to medical school, and about two years later she wound up acing the LSAT and is now on a good scholarship with two top 10 law schools having a bidding war for her. As she only is interested in public work, scholarships are pretty important.

I doubt such proposed deals are so uncommon, so being able to negotiate more openly for salary and benefits might discourage otherwise less-than-perfectly-ethical things from being pursued. But otherwise the Match is a pretty applicant-friendly program. And I guess if my wife didn't mind deals made in smoky backrooms, it would have been pretty sweet for us too.