Do programs not get the same funding from the government if they prematch?

[RussianJoo]

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I am planning on asking a program for a prematch, my only concern is the program is very small, only 4 residents, and the only reason I can see why they wouldn't prematch me is if they won't get the same funding from Medicare as they would if they go through the match . And thus would tell me to go through the match and that they would rank me to match.

So this question is especially for AprogramDirector.. do residency programs get the same funding if they get their residents through the match or outside the match? what are the disadvantages of why a program would prefer to go through the match as apposed to prematching their residents?

I know programs get over $100K per resident per year from Medicare..

Thank you in advance for your comments.

 

[DreamMachine]

I am planning on asking a program for a prematch, my only concern is the program is very small, only 4 residents, and the only reason I can see why they wouldn't prematch me is if they won't get the same funding from Medicare as they would if they go through the match . And thus would tell me to go through the match and that they would rank me to match.

So this question is especially for AprogramDirector.. do residency programs get the same funding if they get their residents through the match or outside the match? what are the disadvantages of why a program would prefer to go through the match as apposed to prematching their residents?

I know programs get over $100K per resident per year from Medicare..

Thank you in advance for your comments.

Same funding if you take a spot outside the match.

 

[RussianJoo]

Same funding if you take a spot outside the match.

thank you, so then there really is no financial downside for a program to prematch someone? Will a spot in the match be taken away from a program for next year if they prematch someone this year and submit one or two spots less than what they're allowed to have?


So theoretically the only downside to a program prematching someone is that there's a chance that a better applicant might apply in the match, and they would miss out on him/her because they have one less spot to fill?

 

[DreamMachine]

thank you, so then there really is no financial downside for a program to prematch someone? Will a spot in the match be taken away from a program for next year if they prematch someone this year and submit one or two spots less than what they're allowed to have?


So theoretically the only downside to a program prematching someone is that there's a chance that a better applicant might apply in the match, and they would miss out on him/her because they have one less spot to fill?

That is all correct as I understand it.

 

[RussianJoo]

That is all correct as I understand it.

So they will lose a residency spot for next years match? hmm then they might not be too happy to prematch anyone.

 

[SoCuteMD]

So they will lose a residency spot for next years match? hmm then they might not be too happy to prematch anyone.

Yes, if you prematch then they have one less spot for your entering class. Programs do not have the discretion to increase their class size because they feel like it, either. It involves approval from the RRC based on case numbers. It also involves shuffling around some residency spots if the program is relying on Medicare funding for funding as I believe the number of Medicare-funded spots is static from year to year at the moment.

 

[Winged Scapula]

So they will lose a residency spot for next years match? hmm then they might not be too happy to prematch anyone.

They do not LOSE spots.

If a hospital is approved for 400 residency positions, and <insert specialty X> is approved for 4 of those positions, if they offer a pre-match, no spots are lost - not your year or the year after. The number of CMS funded spots is hospital wide, not program wide; this is why sometimes programs can "trade" a position.

A hospital that participates in the NRMP has to offer a certain percentage of its positions in the match - 75% IIRC. Thus, they can offer a prematch and then offer the rest of their positions in the match, as long as they meet the contractual agreement with NRMP.

The program still ends up with 4 residents (your pre-match and 3 residents from the match) provided they fill in the upcoming match. Some programs do not offer pre-matches at all - some because of hospital or department policy, others because of the misguided belief that they aren't allowed to.

The major drawback is the same for both parties - you take what you are offered without knowing whether or not you could have matched into something "better" and they take you without knowing what the applicant pool is like and they could have gotten someone "better".

 

[RussianJoo]

Yes, if you prematch then they have one less spot for your entering class. Programs do not have the discretion to increase their class size because they feel like it, either. It involves approval from the RRC based on case numbers. It also involves shuffling around some residency spots if the program is relying on Medicare funding for funding as I believe the number of Medicare-funded spots is static from year to year at the moment.

No I didn't mean for my year.. i know that they'll have one less spot for the year i prematch.. i meant for the future years, like for the next years match..

 

[RussianJoo]

They do not LOSE spots.

If a hospital is approved for 400 residency positions, and <insert specialty X> is approved for 4 of those positions, if they offer a pre-match, no spots are lost - not your year or the year after. The number of CMS funded spots is hospital wide, not program wide; this is why sometimes programs can "trade" a position.

A hospital that participates in the NRMP has to offer a certain percentage of its positions in the match - 75% IIRC. Thus, they can offer a prematch and then offer the rest of their positions in the match, as long as they meet the contractual agreement with NRMP.

The program still ends up with 4 residents (your pre-match and 3 residents from the match) provided they fill in the upcoming match. Some programs do not offer pre-matches at all - some because of hospital or department policy, others because of the misguided belief that they aren't allowed to.

The major drawback is the same for both parties - you take what you are offered without knowing whether or not you could have matched into something "better" and they take you without knowing what the applicant pool is like and they could have gotten someone "better".

Thank you for your reply.. So then if they start telling me that they really want to prematch me but they're not allowed to offer a prematch because they'll lose a spot for the upcoming years or won't get medicaid funding for a prematch should i tell them that it's not true and that they should check with NRMP.. or should i just take that as them giving me the run around and just being nice and not straight up rejecting me?

 

[NotAProgDirector]

Agreed that medicare funding is independent of match status, and that spots are not "lost" -- this program could prematch you and then match 3 others this year, and then match 4 next year.

A hospital that participates in the NRMP has to offer a certain percentage of its positions in the match - 75% IIRC.

I believe this is not exactly correct. The NRMP requires that overall 75% of the spots be in the match. Thus, some programs may have 100% of their spots in the match, and some may have 0% in the match (and hence prematch everyone), but as long as 75+% of the spots are in the match as a whole, there is no problem. If more than 25% of the spots are given away before the match, the match starts to degenerate -- programs start to worry that all the good applicants will take a prematch, so they start offering prematches, which sends the applicants into a panic...

Thank you for your reply.. So then if they start telling me that they really want to prematch me but they're not allowed to offer a prematch because they'll lose a spot for the upcoming years or won't get medicaid funding for a prematch should i tell them that it's not true and that they should check with NRMP.. or should i just take that as them giving me the run around and just being nice and not straight up rejecting me?

Either scenario is possible. You will need to decide what makes the most sense.

 

[Winged Scapula]

I believe this is not exactly correct. The NRMP requires that overall 75% of the spots be in the match. Thus, some programs may have 100% of their spots in the match, and some may have 0% in the match (and hence prematch everyone), but as long as 75+% of the spots are in the match as a whole, there is no problem.

I thought that was what I was saying.😕

Perhaps my earlier post was confusing...the above is what I was referring to. Overall 75% of possible positions within a system must be offered through the NRMP (not 75% per residency program), if contracted with the NRMP. Thus, some can totally fill using the match, some partially and some not at all.

 

[Winged Scapula]

Agreed that medicare funding is independent of match status...

Thank you...it seems that there is some discrepancy with others here believing that pre-matched residents get paid less, if not on a regular basis, at least frequently enough that several users are claiming its true.

Outside of being paid with non-CMS funds, do you believe the above posters are in error (ie, 2nd hand info) or is there some other explanation that I haven't thought of.

 

[Winged Scapula]

Thank you for your reply.. So then if they start telling me that they really want to prematch me but they're not allowed to offer a prematch because they'll lose a spot for the upcoming years or won't get medicaid funding for a prematch should i tell them that it's not true and that they should check with NRMP.. or should i just take that as them giving me the run around and just being nice and not straight up rejecting me?

Who knows.

Perhaps they really don't know the rules of the match or they're just trying to break it to you gently. As aPD notes, depends on the "vibe" you're getting from them.

 

[RussianJoo]

thank you very much Aprogram Director and Winged Scapula..

2 attendings have offered to talk to the chairman on my behalf, those can't be bad signs, the others were happy working with me. I still have to work with the chairman and program director so we'll see how that goes.. I know of a few people that signed outside the match at this program although they didn't sign contracts this early in the year.

I am waiting for my step2 scores to come in and as long as they're solid and I impress the chairman and program director i'll have the prematch talk with them.

thanks again for your comments, it's great to know that there are no major downsides for a program to prematch someone, especially if they have the grades/scores to be competitve and work well with the faculty.